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.

Establish Medical Necessity with CMS’ Documentation Guidelines

It is the responsibility of CMS to administer Medicare and other federally mandated healthcare programs throughout the United States. Medicare prohibits payment for services and items deemed by local Medicare Carriers as not medically reasonable and necessary for the diagnosis or treatment of an illness or injury, so here documentation is essential for claims to be paid.

There are a couple of points that a physician needs to ensure like only tests that are medically necessary in diagnosing or treating their patients should be asked for, correct ICD-9 codes to be used for patient files and test request forms, advance beneficiary notes to be signed by patients in