Effective October 1, CMS will fundamentally alter the manner in which hospitals define how inpatient status and outpatient observation is determined. As President of SG’s Care Management division, it is my responsibility to inform providers of these changes. The IPPS 2014 Final Rule contains two provisions that directly affect the day to day operations of the hospital. First, CMS has made significant changes to the criteria for medical necessity coverage concerning Part A inpatient hospital claims. Additionally, they have defined the manner in which providers can bill services under Part B following the determination that a Part A inpatient claim is denied based on medical necessity.

Compliance with the new time based medical necessity guidelines will be centered on an organization’s ability to be agile through the implementation of new proformas, the application of prospective technology solutions and the interaction of these with retrospective data analytics. Additionally, physician education and compliance with increased documentation demands will be paramount.

You are invited to attend a free webinar on Wednesday, September 25 (11:00 am Pacific / 1:00 pm Central / 2:00 pm Eastern).

By attending this webinar, you will learn: 

  • How the new time-based inpatient status rules will affect your hospital
  • Strategies for implementation and compliance
  • How to successfully manage Part A to Part B rebilling

We hope you will dial in for this one-of-a-kind webinar! If you have any questions or to request more information, email me at Robert_Wagner@schumacherclinical.com.