National Government Services (NGS), under contract to the Centers for Medicare & Medicaid Services (CMS), has announced additional listening sessions on end-to-end testing for April. These listening sessions are essential in gathering insights and feedback from the healthcare industry on end-to-end testing of ICD-10 and other HIPAA administrative simplification requirements.
Complementary rules may extend electronic health record (EHR) safe harbor for an additional three years to encourage adoption. The proposed rules, one from the Centers for Medicare & Medicaid Service (CMS) and another from the Office of Inspector General (OIG) extend the 2006 rules relaxing federal Stark and anti-kickback laws from December 2013 to December 2016.
A proposed rule released March 13 by the Centers for Medicare & Medicaid Services (CMS) may help alleviate the financial burden hospitals encounter when a claim is denied as not reasonable and necessary because a patient was improperly admitted and treated as an inpatient rather than as an outpatient.
There is a limited list of Medicare Part B inpatient services currently allowed when a Part A inpatient admission is denied as not reasonable and necessary. To date, under the Medicare Benefit Policy Manual (MBPM), chapter 6, section 10, a limited set of Part B inpatient services may be paid in the following circumstances:
- No Part A prospective payment is made at all for the hospital stay because of patient exhaustion of benefit days before admission.
- The admission was disapproved as not reasonable and necessary (and waiver of liability payment was not made).
- The day or days of the otherwise covered stay during which the services were provided were not reasonable and necessary (and no payment was made under waiver of liability).
- The patient was not otherwise eligible for or entitled to coverage under Part A.
In the proposed rule, Medicare Program; Part B Inpatient Billing in Hospitals (CMS-1455-P), CMS is recommending that if a patient is enrolled in Part B, Medicare would pay for all reasonable and necessary Part B hospital inpatient services when a Part A inpatient admission is denied as not reasonable and necessary.
The Centers for Medicare & Medicaid Services (CMS) began February by releasing a long-overdue Sunshine Act requiring the disclosure of financial relationships between doctors and industry in compliance with President Obama's health care law.