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.
This week’s note is about CMS’ offer to certain hospitals regarding withdrawing appeals for partial payments. Click the link above for more information and an in-depth analysis.
CMS' Conditions of Participation for UR include specific requirements for the composition of the UR committee, specifying that it must be composed of at least two doctors of medicine or osteopathy.
At many hospitals the terms Utilization Management (UM) and Utilization Review (UR) are used interchangeably. Are they the same thing? No, they're not, according to Stefani Daniels, RN, MSNA, ACM, CMAC, and Ronald L. Hirsch, MD, FACP, CHCQM.
Do observation patients belong in their own unit? The answer is debated at many organizations. Some say establishing a separate unit brings numerous advantages, from improved ED throughput to shorter lengths of stay. Others say some facilities may not need one.
Case managers rejoice. CMS recently sounded what is being called the death knell of the 2-midnight rule certification in a final rule published in the November 10, 2014, Federal Register.
Is your organization complying with the 2-midnight rule? Now is the time to conduct an internal audit and find out. If you don’t, a Medicare auditor may beat you to it.
Last month, CMM outlined the new CMS 2014 inpatient prospective payment system (IPPS) guidelines, which revised inpatient admission standards (see correction on p. 4). This month we're going to offer some tips to assist you to help physicians document accurately, and inform you about some other changes that will affect the way case managers do business when it comes to meeting the new standard.
