CMS Documentation Guidelines for FY 2014 Inpatient Payment Rule

The Medicare program, PPS payment system, and consolidated billing are updated every year by CMS. It has a profound impact on practices so it is essential to understand each and every CMS documentation guideline. Recently CMS issued the final version that updates FY 2014 Medicare payment policies and rates related to general acute care and LTCHs. This new rule brings about an improvement in the value and quality related to hospital care and provides an explanation regarding the circumstances under which a patient can be admitted to the hospital. It also addresses recent concerns related to prolonged Medicare beneficiary stays in the hospital outpatient department.

The FY2014 final IPPS rule has increased overall payment for hospitals by $1.2 billion. The Affordable Care Act has also made reforms related to health care delivery system along with this rule. It includes a program that will help to improve safety in hospitals and bring clarity to the Hospital Readmissions Reduction program.

The IPPS operating rate will be increased by 0.7% with the final rule, after taking into account inflation and other changes that the law requires. A temporary reduction of 0.8% occurs due to the increase to imply the American Taxpayer Relief Act’s requirement to get back all the previous overpayments which is the result of a new patient classification system that helps to identify the extent of the illness.

0.2% reduction is also being made to make up for increase in spending that has been projected associated to changes in the review process of medical and admission for inpatient services. There will be a hike of nearly 1.3% in LTCH PPS payments as projected by CMS in FY 2014.

The changes to Medicare quality incentive programs will help to decrease the reporting trouble that providers face in the EHR and IQR program. This will also enable to finalize new procedures for Hospital Inpatient Quality Reporting Program, the Hospital Value-Based Purchasing program, and LTCHs, PPS.  But cancer and Inpatient Psychiatric Facilities are excluded.

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