CMS Releases Final IPPS Rules for 2013-14

The Centers for Medicare & Medicaid Services (CMS) last week published the 2014 Inpatient Prospective Payment System (IPPS) Final Rule that contains few, if any surprises, but still won’t make healthcare providers happy.

CMS  ratified the changes it proposed back in April, including the definition of what makes an inpatient hospital stay “medically necessary.”

For a hospital to admit a patient and be reimbursed by Medicare, a physician must order admission from the outset and that order must be supported by admission notes and progress notes, and other relevant documentation, the rules state. As promised in the draft rules, CMS is holding to the “two midnights” standard, meaning that inpatient status can be applied to those patients whose stay overlaps two midnights.

The new IPPS rules also establish the conditions whereby providers can bill under Medicare Part B for services that have been denied under Part A. However CMS has ruled it will not accept Part B submittals more than one year after delivery of the service. Providers and their representative organizations have protested this provision, especially as some Part A denials can take longer than a year before they are eventually resolved.