Hospital
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Spotlight
- Availability of the list of essential medicines considered to be in shortage for the purposes of the recently finalized separate IPPS payment for establishing and maintaining access to essential medicines
- View CMS Newsroom Center (Spotlights, news, media releases, outreach, mailing lists, etc.)
- CMS Quarterly Provider Updates (QPU)
- Hospital Price Transparency
LCD / NCD – policy information
LCDs
Search for hospital-related LCDs using these available tools:
- LCD interactive index tool
- View First Coast’s active / proposed LCDs / articles on CMS’ Medicare coverage database (MCD)
NCDs
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
Audit and compliance
- CERT resources
- Recovery Auditor (RA) resources
- CMS Certification & Compliance
- Billing for Hospital Part B Inpatient Services (MM11181)
- Swing Bed Services -- Fact Sheet (ICN 006951)
- Provider Compliance Tips for Hospital Beds
- OIG study -- Assessing Inpatient Hospital Billing for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services and the Office of Inspector General have identified problems with upcoding in hospital billing. OIG will conduct a two-part study to assess inpatient hospital billing.
Frequently asked questions (FAQs)
Before you call the First Coast provider contact center, view our specialty / services FAQs for additional information.
Education
Utilize educational information from First Coast and CMS on related hospital information.
- Upcoming events
- Visit On-Demand Learning – access First Coast’s webcast recordings, videos, and tutorials.
CMS educational opportunities
Resources
- Hospital ID and contact information
- Related CMS internet-only manuals (IOM)
Find operating instructions, policies, and procedures for hospital inpatient and outpatient services. - Find additional resources identified specifically for hospitals
Inpatient MS-DRG
- Checklist: Inpatient admission documentation
- Hospital inpatient admission order and certification
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. - Selecting hospital claims for patient status reviews
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. - Guidance on hospital inpatient admission decisions
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