The Medicare Outpatient Prospective Payment System final rule for calendar year 2022 continues cuts to hospitals in the 340B Drug Pricing Program and pauses elimination of the inpatient-only list. The rule also includes provisions on price transparency, rural emergency hospitals, and health equity.
view more »Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule would continue Medicare Part B cuts, continue site-neutral policies, and halt the phase-out of the inpatient-only list. Both rules also contain an information request on closing the health equity gap.
view more »Association Comments on FY 2022 IPPS Proposed Rule
June 29, 2021 ||America's Essential Hospitals commented on several policy proposals of interest to essential hospitals in the Inpatient Prospective Payment System rule and responded to a request for information on closing the health equity gap in hospital quality programs.
view more »Hospital Compare January Preview Reports Include Star Ratings
Nov. 5, 2019 ||Health care providers have until Dec. 3 to download their preview reports, which include overall hospital quality star ratings.
view more »CMS Releases Updated Medicare Cost and Usage Data
June 29, 2016 ||This year’s release includes some changes in both the information released and its classification.
view more »CMS Clarifies Sepsis Measure in IQR Program
Feb. 24, 2016 ||Guidance on the new sepsis measure (SEP-1) is now available on QualityNet, including what documentation can be used for data elements in the chart-abstracted measure.
view more »CMS, ONC Seek Information on Quality Reporting Processes
Jan. 6, 2016 ||Agencies seek information on quality reporting to help reduce the burden on eligible hospitals and providers; comments are due Feb. 1.
view more »Hospitals: Review Quality Measure Reports by Oct. 7
Sept. 23, 2015 ||The dry run reports are for a new claims-based outcomes measure that will be included in the IQR Program starting in fiscal year 2018. Hospitals have until Oct. 7 to access this report through QualityNet.
view more »CMS Extends Partial Enforcement Delay of Two-Midnight Policy
Aug. 13, 2015 ||RACs will not conduct postpayment reviews of patient status for Medicare claims with an inpatient admission between Oct. 1 and Dec. 31, 2015.
view more »Agency proposes to reduce slightly payment rates for hospital outpatient services, relax some provisions of the two-midnight policy, and update quality reporting measures.
view more »Process Improvement Steps to Slash Patient Fall Rate
June 22, 2015 ||Process improvement methodology led to a 40 percent reduction in patient falls at Broward Health Imperial Point after just one year.
view more »CMS Releases Hospital Medicare Payment Data
June 2, 2015 ||Annual release includes 2013 data related to the 100 most common diagnoses for Medicare patients requiring inpatient stays and 30 selected outpatient procedures.
view more »Association Supports Two-Midnight Rule Legislation
March 11, 2014 ||The legislation would extend the partial enforcement delay of the two-midnight policy and require CMS to develop new criteria for inpatient stays that last fewer than two midnights. Association President and CEO Bruce Siegel, MD, MPH, said, "It's vitally important that we get this policy right so that we don't inadvertently destabilize hospitals that care for the vulnerable."
view more »CMS Posts Additional Two-Midnight Guidance
March 5, 2014 ||CMS stated that MACs must re-review all claims denials under the probe and educate process. CMS also released a new document that provides initial data collected from the inpatient hospital probe and educate reviews.
view more »OIG and HHS Release FY 2014 Work Plan
Feb. 25, 2014 ||The OIG and HHS FY 2014 work plan includes several Medicare and Medicaid projects. These projects cover the following topics including inpatient admission criteria, E&M payments, IME, and provider taxes.
view more »CMS Call on Two-Midnight Policy Feb. 27
Feb. 19, 2014 ||CMS will discuss inpatient hospital admission and medical review criteria and answer questions. A partial delay of the policy was instituted Nov. 5, 2013, and extended Jan. 31. Now recovery audit contractors and Medicare administrative contractors will not conduct postpayment patient status reviews for inpatient admissions with dates of service between Oct. 1, 2013 and Sept. 30, 2014.
view more »CMS Extends Two-Midnight Delay for Additional Six Months
Feb. 7, 2014 ||CMS posted further guidance extending the partial delay of the two-midnight policy for inpatient admission and medical review through Sept. 30. For inpatient admissions with dates of service between Oct. 1, 2013 and Sept. 30, 2014, recovery audit contractors and Medicare administrative contractors will not conduct postpayment patient status reviews.
view more »Inpatient population and sampling data for chart-abstracted quality measures for the third quarter of 2013 (discharges from July 1 through Sept. 30, 2013) will be due Feb. 8 for the IQR Program. Outpatient population and sampling data and outpatient chart-abstracted measures will be due Feb. 8 for the OQR Program.
view more »CMS to Host Training Session on Two-Midnight Policy
Jan. 7, 2014 ||Call will cover inpatient hospital admission, medical review criteria and offer case scenarios
view more »America’s Essential Hospitals Urges CMS to Delay Enforcement of Two-midnights Policy
Nov. 26, 2013 ||Revised policy presumes inpatient admissions fewer than two midnights are inappropriate for inpatient reimbursement
view more »Value-Based Purchasing (VBP) Program Rules and Comments
Nov. 25, 2013 ||The VBP program links Medicare inpatient payments to quality measure performance
view more »Offered direction on how to select hospital claims during inpatient probe and educate program
view more »Rule establishes presumption of medical need for Medicare hospital inpatient admissions that span two midnights
view more »Cited concerns that hospitals may be undercompensated for providing necessary services that do not meet new criteria
view more »CMS to Host Call on FY 2014 IPPS Provisions Aug. 15
Aug. 13, 2013 ||Will take comment on physician order and certification, medical review criteria, and other issues
view more »CMS to Host National Provider Calls, Dry Runs for New IQR Program Claims-based Measures
Aug. 13, 2013 ||Hospital inpatient quality reporting program intended to provide consumers with quality of care information
view more »Responds to CMS concern that Medicare and beneficiaries might pay more for outpatient care
view more »Education targeted at staff involved in reporting summary data to the National Healthcare Safety Network
view more »Association urges CMS to accurately capture uncompensated care data to implement Medicare DSH cuts
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