sábado, 10 de agosto de 2013

Rural Health Open Door Forum - Centers for Medicare & Medicaid Services

http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_ruralhealth.html

Centers for Medicare & Medicaid Services

Special Open Door Forum:

CMS Rule 1599-F: Inpatient Hospital Admission and Medical Review Criteria (2-Midnight Provision) and Part B Inpatient Billing in Hospitals.

Thursday, August 15, 2013

3:00pm – 4:00pm Eastern Time

Conference Call Only

CMS will host a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F).

The final rule instructs the physician on when an inpatient hospital admission should be ordered and certified, and clarifies for the practitioner and facility when inpatient hospital admissions are generally appropriate for Medicare Part A payment. The new rules are intended to address concerns about some Medicare beneficiaries having long stays in the hospital as outpatients and improve program integrity. Under the rule, if a physician expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary to the hospital based on that expectation, it is generally appropriate that the hospital receive Medicare Part A payment. The final rule emphasizes the need for a formal order of inpatient admission to begin inpatient status, but permits the physician to consider all time a patient has already spent in the hospital as an outpatient receiving observation services, or receiving care in the emergency department, operating room, or other treatment area in guiding their two-midnight expectation.

We finalized our proposal to continue applying the timely filing restriction to the billing of all Part B inpatient services, under which claims for Part B services must be filed within 1 year from the date of service. However, we will permit hospitals to follow the Part B billing timeframes established in CMS Ruling-1455-R after the effective date of the final rule (October 1, 2013), provided (1) the Part A claim denial was one to which the Ruling originally applied; or (2) the Part A inpatient claims has a date of admission before October 1, 2013, and is denied after September 30, 2013 on the grounds that although hospital outpatient services would have been reasonable and necessary, the inpatient admission was not. In the final rule, we also discussed appeals, beneficiary liability and other impacts of our final policies.

You can find the final rule by going to: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2014-IPPS-Final-Rule-Home-Page.html

Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule.

Special Open Door Participation Instructions:

Dial: Participant Dial-In Number(s): (877) 251-0301
Conference ID # 31049561

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Rural Health Open Door Forum

Overview:
The Rural Health Open Door Forum (ODF) addresses Rural Health Clinic (RHC), Critical Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. Topics that frequently arise on this forum often deal with payment & billing for services subject to Health Professional Shortage Area (HPSA) and/or Physician Shortage Area (PSA) status, cost report clarifications, classifications for & qualifications of rural provider types, and the many special provisions being implemented for improving rural health in the Medicare Modernization Act of 2003. Timely announcements and clarifications regarding important rulemaking, quality program initiatives, and other related areas are also included in the Forums.
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CMS will host a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F). If you wish to participate, dial 1-877-251-0301; Conference ID: 31049561. Please see the full announcement in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
The Centers for Medicare & Medicaid Services will host an ICD-10 Basics National Provider Call on Thursday, August 22, 2013, from 1:30-3:00pm ET. The target audience is medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers. Please see the Downloads section below for the full announcement including registration instructions. Thank you.
CMS is hosting a series of EHR Incentive Program related national calls. The calls will take place on July 23, 2013, July 24, 2013 & August 15, 2013. Please see the Downloads section below for registration information.
CMS is developing a registry of Medicare providers for participation in the MSI. To accomplish this effort, CMS is seeking to collect accurate contact information by having providers complete the MSI Participant Registration form. The form itself is not a survey. It is a method for gathering pertinent contact information such as name, email address, state, etc. It should take less than 1 minute to complete. For each MSI administration, CMS will randomly select its MSI sample from a list of providers who register to become participants. Please see the Downloads section below for the full registration announcement.
An updated agenda has been posted in the Downloads section for the Wednesday, July 10, 2013 Rural Health Open Door Forum. If you wish to participate, dial 1-800-837-1935; Conference ID: 14440061. Thank you for your continued interest in the CMS Open Door Forums.
The next Rural Health Open Door Forum is scheduled for Wednesday, July 10, 2013 from 2:00pm – 3:00pm ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 14440061. An agenda will be posted in the Downloads section below prior to the call. Thank you for your continued interest in the CMS Open Door Forums.
National Provider Calls: Medicare Shared Savings Program Application Process — Register Now
Thursday, June 20; 1:30-3pm ET— Application Review
Thursday, July 18; 1-2:30pm ET— Application Question and Answer Session. Please see Downloads section below for full announcement, including registration instructions.
The next Rural Health Open Door Forum is scheduled for Wednesday, May 29, 2013 from 2:00pm – 3:00pm ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 78861994. Please see the full participation announcement with agenda in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
CMS Seeks Public Comment on Defining QIO Service Areas - Comments Accepted through Friday, May 31, 2013. Please see Downloads section below for full announcement.
CMS will host a National Provider Call on Wednesday, May 22, 2013, titled: National Physician Payment Transparency Program (Open Payments) - What You Need To Know. Please see Downloads section below for full announcement.
The next Rural Health Open Door Forum is scheduled for Wednesday, April 24, 2013, from 2:00pm – 3:00pm, ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 78869914. Please see the full participation announcement with agenda in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
National Provider Calls: Medicare Shared Savings Program Application Process — Registration Now Open
Tuesday, April 9; 2:30-4pm ET— Preparing to Apply
Tuesday, April 23; 1:30-3pm ET— Tips on Completing a Successful Application. See Downloads section below for full announcement.
The CMS Innovation Center will be hosting a conference call on Tuesday, March 12, 2013 from 3:00pm to 4:00pm ET. CMS Innovation Center Director, Richard Gilfillan, MD, and Karen Murphy, RN, PhD, Director of the State Innovations Group, will provide an overview of the Model Testing, Pre-Testing and Model Design awards as well as additional information on how providers can participate in the State Innovation Models initiative. Please see the Downloads section below for the full announcement with participation instructions. Thank you.
The next Rural Health Open Door Forum is scheduled for Thursday, March 7, 2013, from 2:00pm – 3:00pm, ET. If you wish to participate, dial 1-800-837-1935; Conference ID: 91724524. Please see the full participation announcement with agenda in the Downloads section below. Thank you for your continued interest in the CMS Open Door Forums.
Please see the "New Electronic Mailing List to Keep Fee-For-Service Providers Informed" announcement in the Downloads section below.