CMS Changes Rules for Inpatient-Only Procedures

Effective April 1, 2015, hospitals will no longer be required to obtain an order for inpatient admission prior to the performance of an inpatient-only procedure.

In Change Request 9097, issued March 13, 2015, CMS made changes to the OPPS to allow payment for inpatient-only procedures that are done in the outpatient setting on the date of the inpatient admission, or in the three calendar days preceding the inpatient admission (one calendar day for critical access hospitals).  Please note that an appropriate inpatient admission order is still required for admissions related to inpatient-only procedures.  However, under the previous instructions, this order was required to be timed/dated prior to the initiation of the procedure.  With this recent change in instruction, the order may be timed/dated either prior to or following the procedure and the hospital may be reimbursed for the inpatient stay.

We recommend that your facility review internal processes related to inpatient-only procedures in light of this change.

To access the change request, click here.

HC Healthcare Consulting staff includes certified coders, physicians, consultants certified in healthcare compliance, and statisticians that are available to provide expert assistance with your Medicare and Medicaid compliance programs.

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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