Hospital Center
Spotlights
- CMS-1695-CN2: Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction
- CMS-1695-FC: Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs
- CMS-1695-P: Medicare Program: Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Requests for Information on Promoting Interoperability and Electronic Health Care Information, Price Transparency, and Leveraging Authority for the Competitive Acquisition Program for Part B Drugs and Biologicals for a Potential CMS Innovation Center Model
- CMS-1694-P: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2019 Rates; Proposed Quality Reporting Requirements for Specific Providers; Proposed Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Medicare Cost Reporting Requirements; Medicare Appeals Procedures for Coverage and Payment Determinations; and Physician Claims Certifications and Recertifications
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Clinical Laboratory Data Reporting: Enforcement Discretion
On March 30, CMS announced that it will exercise enforcement discretion until May 30, 2017, with respect to the data reporting period for reporting applicable information under the Clinical Laboratory fee Schedule (CLFS) and the application of the Secretary’s potential assessment of civil monetary penalties for failure to report applicable information.
View the announcement and PAMA regulations page.
- CMS-1656-FC: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital
- CMS-1655-F; CMS-1664-F; CMS-1632-F2: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules with Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low Volume Hospitals
- Long Term Care Hospitals Required by the Consolidated Appropriations Act, 2016; Modification of Limitations on Redesignation by the Medicare Geographic Classification Review Board
- Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
On August 19, 2013, in the FY2014 IPPS/LTCH final rule CMS clarified and revised the conditions of payment for hospital inpatient services under Medicare Part A related to patient status. On September 5, 2013, CMS released guidance that discussed the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. This document includes further clarification of issues addressed in the previous guidance. - Prior Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
The guidance provided in this document has been further clarified in Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions. This version of the guidance document will remain online for comparison purposes. - On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) issued Ruling 1455-R which establishes an interim process for hospitals to bill Medicare for Part B services following a denial of a claim for an inpatient admission as not reasonable and necessary. CMS has issued temporary billing instructions for affected providers to follow for both the Part B Types of Bills (TOB), TOB 12x and TOB 13x.
- Blood Clotting Factor Furnishing Fee
- Frequently Asked Questions Regarding Requirements for Hospitals To Make Public a List of Their Standard Charges via the Internet [PDF, 69KB]
- Additional Frequently Asked Questions Regarding Requirements for Hospitals To Make Public a List of Their Standard Charges via the Internet [PDF, 75KB]
MLN Connects Newsletter
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Important Links
Payment
- Acute Inpatient PPS -- New Medical Services and New Technologies and Hospital-Acquired Conditions (Present on Admission Indicator)
- Critical Access Hospitals Center
- Hospital Outpatient PPS
- Long-Term Care Hospital PPS
- Inpatient Rehabilitation Facility PPS
- Inpatient Psychiatric Facility PPS
- Electronic Billing & EDI Transactions : Medicare information on electronic transactions under HIPAA
- Historical Part B Drug Pricing Files
- Transplant Centers
Enrollment, Participation & Certification
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Hospitals
- Critical Access Hospitals
- Psychiatric Hospitals
- Quality, Safety & Oversight - General Information
Policies & Regulations
- IPPS Regulations and Notices
- Hospital Outpatient Regulations and Notices
- IRF Rules and Related Files
- LTCHPPS Regulations and Notices
- IPF PPS Regulations and Notices
- Quarterly Provider Updates
Legislation
Coding
- HCPCS - General Information
- Alpha-Numeric HCPCS
- ICD-9-CM and ICD-10
- ICD-10
-
Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) - Opens in a new window
Educational Resources
Coverage
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Physician Self Referrals -- Specialty Hospitals
- Physician Self Referral
- Disclosure of Financial Relationships Report (DFRR)
- Specialty Hospital Issues
- Specialty Hospital Advisory Opinions
Uninsured Information
- FAQs on Charges for the uninsured [PDF, 24KB]
- FAQ regarding Offering discounts to the uninsured [PDF, 7KB]
CMS Manuals & Transmittals
National Provider Identifier (NPI)
Cost Reporting
- Paper-Based Manuals Provider Reimbursement Manual (Pub 15)
- PRRB Review
Forms
Hospital Value-Based Purchasing
- Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program [PDF, 743KB]
- Agenda - April 12, 2007 Listening Session [PDF, 17KB]
- Slide Presentations - April 12, 2007 Listening Session [ZIP, 465KB]
- Options Paper 2nd Public Listening Session [PDF, 208KB]
- Agenda - January 17, 2007 Listening Session [PDF, 22KB]
- Slide Presentations - January 17, 2007 Listening Session [ZIP, 932KB]
- Issues Paper for the January 17, 2007 Listening Session on a Plan for Medicare Hospital Value-Based Purchasing [PDF, 277KB]
- Special Forum on Hospital Value Based Purchasing [PDF, 212KB]
Initiatives
- Hospital Quality Initiative
- Beneficiary Notices Initiative (BNI)
- Preventive Services
- Provider Resources
Medical Review/ Fraud & Abuse
- Beneficiary Complaint Response Program
Medicare Secondary Payer
Contacts
How to Stay Informed
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- Hospitals Open Door Forum
- Press Releases - Opens in a new window