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McBrayer Blogs
Showing 3 posts in Part A.
Clarifying the “Two-Midnight Rule” and Part A Payments, cont.
Posted In "Two Midnights Rule", Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Hospitals, Inpatient Care, Part A, Part B
Earlier this week, I discussed CMS’ final rule on the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. The final rule provides guidance to physicians on how to designate a patient as inpatient or outpatient and the impact of the designation on Medicare Part A or Part B coverage. This blog will discuss the two midnight rule. More >
Clarifying the “Two-Midnight Rule” and Part A Payments
Posted In "Two Midnights Rule", Centers for Medicare & Medicaid Services (“CMS”), Hospitals, Inpatient Care, Part A, Part B
In August, the Centers for Medicare and Medicaid Services (“CMS”) announced a final rule regarding the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. This rule becomes effective on October 1, 2013. More >
CMS Ruling on Part B Rebilling
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicare Administrative Coordinators, Medicare Benefit Policy Manual, Part A, Part B, Recovery Audit Contractors (“RAC”)
Increasingly, Administrative Law Judges (“ALJs”) and the Medicare Appeals Council were upholding Part A denials on RAC audit appeals based on determinations that inpatient admissions were not reasonable and necessary, and then ordering payment under Part B as if services were rendered at an outpatient or “observation level” of care. The problem with this practice is that Medicare Benefit Policy Manual (“MBPM”) allows hospitals to bill a Part B inpatient claim for only a limited set of medical and other health services. Additionally, the providing for payment of all reasonable and necessary Part B services under these circumstances are contrary to CMS policy that the services be billed within the usual timely filing restrictions. The Centers for Medicare & Medicaid Services (“CMS”), concerned about this practice, recently released both a Ruling and a Proposed Rule to seemingly help the hospital community. How much relief it will actually provide is yet to be seen. More >
