CMS has sharply accelerated its push toward moving outpatient payments from a fee-for-service model to a true prospective payment system with a number of its proposals in the 2016 OPPS proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16577.pdf), including new comprehensive APCs (C-APC) and extensive APC consolidation and reconfiguration.
The 2-midnight rule may get a little tweak if the proposals in CMS' 2016 OPPS proposed rule comes to fruition. The rule proposes that physicians now be granted a little more flexibility when it comes to ordering inpatient admissions, even when the stay is expected to be less than two midnights?provided of course that the stay is justifiable from a medical standpoint and the physician clearly documents his or her thinking on the case.
This week CMS released guidance on the new Place of Service (POS) code for off-campus provider-based facilities, the 2-Midnight Rule, and appeals of claims denied by post-payment review contractors. Each item is short, but provides information on topics important to providers and physicians.
While many providers are still digesting the IPPS Final Rule, muddling through how the OPPS Proposed Rule might impact their bottom line, and kicking rocks because the 2-midnight rule was not chucked, President Obama signed a bill into law on August 6, 2015—and it’s one providers should note. Unanimously approved by both the House and Senate earlier this year, the Notice of Observation Treatment and Implication for Care Eligibility Act, otherwise called the NOTICE Act, will not take effect until August 2016, but will certainly add one more layer to the administrative burden associated with outpatient observation services when it does.
This week’s note is about the changes to the 2-Midnight Rule in the 2016 OPPS proposed rule. In the 2016 OPPS Proposed Rule, CMS announced that October 1, 2015 they will be transitioning the medical review of inpatient admissions from Medicare Administrative Contractors (MAC) to Quality Improvement Organizations (QIO). This policy will limit the future review of inpatient admissions by the Recovery Auditors and may be related to CMS’ withdrawal of the Request for Quotes for new Recovery Auditors announced July 10.
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.
