IPPS Proposed Rule Pinches Hospitals
The proposed IPPS rules are more about staying the course than breaking new ground, several observers say.
"It's 1,700 pages of a pretty boring rule," Eric Hammelman, VP of data analytics at DC-based Avalere Health, said Friday.
Anyone expecting CMS to chart a new course on its so-called "two-midnight rule" for hospital admissions is surely disappointed. Under the rule CMS set last summer, patients who stay at a hospital for a period of time spanning less than two midnights are generally considered appropriate for payment at outpatient rates under Medicare Part B. Inpatient hospital stays are reimbursed at the higher Medicare Part A rate.
In its proposal, CMS invites providers to offer exceptions to the two-midnight rule via email for inclusion on a list of procedures that are automatically designated for inpatient payment. But there is no new guidance on the rule.
"They didn't change any of the regulations," Paul Clark, a supervisor at Wolters Kluwer's Health Reform KnowlEDGE Center, said Thursday. "They just repeated guidance that RACs are at bay until March 2015."
Medicare recovery audit contractors are the biggest two-midnight rule losers for now, he says. "[Contractors] are not going to be making as much money. They are not happy."
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