This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used […]
Procedures That Will be Paid Only as Inpatient for CY2015 This is a zip file for download. CPT® license agreement required. CY2015 OPPS Addenda [ZIP, 2.8 MB] (The 2015 Inpatient Only List is here as Addendum E.) It is available as an Excel file or as a Text file. Effective April 1, 2015, a new […]
Clinicians: Signature Value
A white paper is available from AQ-IQ regarding the new modifiers effective January 1, 2014. Download it here.
According to CMS, some of the changes implement certain statutory provisions contained in the Affordable Care Act and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. There are updates to the rate of increase limits for certain hospitals excluded from the IPPS that are […]
CMS issued a proposed rule on April 20, 2014 that would update fiscal year (FY) 2015 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs). This rule builds on the Obama administration’s efforts through the Affordable Care Act to promote improvements in hospital care that will lead […]
Compliance: Analysis of the Two Midnight Rule
Procedures That Will be Paid Only as Inpatient for CY2014 This is a zip file for download. CPT® license agreement required. CY2014 OPPS Addenda [ZIP, 1.8 MB] (The 2014 Inpatient Only List is here as Addendum E.)
CMS Transmittal 1203 dated March 22, 2013 MLN Matters (revised July 6, 2013) These documents provide guidance for billing Part B inpatient claims and the use of condition code W2.