CMS' 2014 IPPS final rule redefined inpatient admissions when it implemented the 2-midnight rule, which requires a validated physician order, documentation of medical necessity, and the expectation of a stay crossing two or more midnights.
Quality measures, such as the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program, form the basis of the 2015 IPPS final rule, released August 4.
The hospital/health system revenue cycle has a significant role in hospital billing compliance. The billing department is the final gatekeeper for compliance, as it is the final area to touch a bill before it is sent to Medicare. Therefore, it is essential that billing staff understand key compliance risk areas.
