News & Analysis

January 4, 2021
Medicare Web

Q: Are procedures removed from the inpatient-only (IPO) list in 2021 subject to the 2-midnight rule?

November 18, 2020
Medicare Web

The Office of Inspector General (OIG) is planning to audit hospital inpatient claims for compliance with the 2-midnight rule, according to a recent update to its Work Plan.

August 4, 2020
Medicare Web

Facing the unprecedented COVID-19 public health emergency, CMS released the 2021 OPPS proposed rule later than ever before, with the agency generally reinforcing its recent focus on site-neutral payment policies, lowering reimbursement for drugs purchased under the 340B program, and adding more services to the list of prior authorization. 

March 16, 2020
Medicare Web

Q: Are lab tests included the Comprehensive APC for observation services?

March 9, 2020
Medicare Web

Q: How many hours of observation services must a patient receive before the hospital is required to provide them with the Medicare Outpatient Observation Notice (MOON)?

March 1, 2020
Briefings on APCs

Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.