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Final IPPS Rule Elicits Objections from Hospital Groups

Cheryl Clark, for HealthLeaders Media, August 5, 2013

That's been problematic, because if patients are not classified as inpatients for three days or more, Medicare Part A will not pay for subsequent nursing home care, and beneficiaries will be billed under Part B a larger shares of their hospital costs.

In a press statement released with the rule, CMS said the 2014 document "provides greater clarity" by specifying that "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," an inpatient stay is appropriate for Medicare Part A payment.

The rule also limits hospitals to rebill Medicare Part B for hospital inpatient services inappropriately billed under Part A by one year from the date of service, applying "to admissions with dates of service on or after Oct. 1, 2013."

But Linda Fishman, senior vice president of the American Hospital Association, says that "while hospitals have wanted clarification of inpatient admission criteria, this final rule is unlikely to reduce the number of appeals of Part A claim denials, which CMS said was one of the primary goals of its rulemaking.

"In addition, we are disappointed that CMS chose to implement a .2 percent cut related to this proposal.

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