Spotlight on success
Medical documentation problems cause hospitals to experience millions of dollars in denied or delayed Medicare claims each year.
Read more about how one hospital has successfully overcome this challenge.
Learn the answers to providers’ most frequently-asked questions pertaining to inpatient admissions and diagnosis-related groups.
This checklist is an aid to assist providers with responding to medical record documentation requests.
Search here for additional articles pertaining to inpatient diagnosis-related groups.
The Centers for Medicare & Medicaid Services (CMS) plans to issue guidance to Medicare administrative contractors (MACs). The guidance CMS issues for determining the appropriateness of inpatient hospital admission and payment language will provide further guidance on the FY 2014 Hospital IPPS Final Rule CMS-1599-F. This regulation described two distinct, although related, medical review policies: a two-midnight presumption and a two-midnight benchmark. This article was updated November 27, 2013, to add a potential exception to the two-midnight rule.
In this special edition article, the Centers for Medicare & Medicaid Services (CMS) stresses the importance of staying informed of all CMS national inpatient hospital policy and national and local coverage determinations regarding making a clinical decision to admit a patient. The article was revised July 31, 2012, to reflect current web addresses. [SE1037]
Final rule CMS-1599-F modifies and clarifies the Centers for Medicare & Medicaid Services’ (CMS’s) longstanding policy on how Medicare administrative contractors (MACs) review inpatient hospital admissions for payment purposes. This document contains a summary of the direction the CMS has issued to MACs.
Final rule CMS-1599-F clarified and revised conditions of payment for hospital inpatient services under Medicare Part A related to patient status. This document provides guidance on provisions regarding required physician order and certification of hospital inpatient services.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.