Hospital -- additional resources
Hospital (inpatient and outpatient) -- additional resources
Listed below are additional resources identified specifically for hospitals.
First Coast resources
View recently released articles on billing and coverage from the First Coast Medicare website.
- Hurricane and disaster related resources
- Prior authorization program for certain hospital outpatient department services
CMS resources
- Visit the Hospital Center on the Centers for Medicare & Medicaid Services (CMS) website.
- Web Pricers webpage -- provides Pricer information for hospitals and facilities providing services to Medicare beneficiaries.
- Acute care inpatient hospitals
- Acute inpatient prospective payment system (IPPS) webpage -- provides an overview and additional information regarding IPPS.
- Acute care hospital IPPS payment policy Medicare Learning Network (MLN) educational tool -- provides a detailed overview of the acute care hospital IPPS.
- Medicare does not pay acute-care hospitals for outpatient services they provide to beneficiaries in a covered Part A inpatient stay at other facilities -- MLN Matters special edition article SE17033
- Fiscal year (FY) 2023 inpatient and long-term care hospital PPS changes -- MLN Matters (MM) article 12814 implements policy changes for FY 2023 IPPS and LTCH PPS, effective for hospital discharges occurring on or after October 1, 2022, through September 30, 2023, unless otherwise noted.
- FY 2022 inpatient and long-term care hospital PPS changes -- MLN Matters (MM) article 12373 implements policy changes for FY 2022 IPPS and LTCH PPS, effective for hospital discharges occurring on or after October 1, 2021, through September 30, 2022, unless otherwise noted.
- Hospital Inpatient Admission Order and Certification -- This CMS memorandum provided detailed guidance on inpatient certification & orders and applies to all inpatient hospital and critical access hospital (CAH) services unless otherwise specified.
- Acute inpatient prospective payment system (IPPS) webpage -- provides an overview and additional information regarding IPPS.
- CAHs
- Visit the Critical Access Hospitals Center on the CMS website.
- Information for Critical Access Hospitals booklet -- provides a detailed overview of the CAH payment methodology and explains how to properly document and bill for services.
- Office of Inspector General (OIG) report (A-06-21-05003) -- OIG found Medicare improperly paid CAHs and health care professionals for the same CAH services. Reminder -- A CAH can only bill for facility and professional outpatient services if the physician or practitioner reassigns their billing rights to them.
- Additional processing procedure for adding a new provider-based location for CAHs -- CR 11246 provides an update to the processing instructions for CAHs.
- CMS Certification & Compliance for CAHs
- Hospital and CAH swing bed manual revisions -- MM10962 clarifies policies related to hospitals and CAHs with respect to services furnished to swing bed patients, including policies related to pass-through reimbursement for Certified Registered Nurse Anesthetist (CRNA) services.
- Visit the Critical Access Hospitals Center on the CMS website.
- Outpatient hospitals
- Hospital outpatient prospective payment system (OPPS) webpage -- discusses the authority for CMS to implement OPPS under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients that have no Part A coverage, and partial hospitalization services furnished by community mental health centers.
- Hospital outpatient prospective payment system MLN educational tool -- provides a detailed overview of the hospital OPPS.
- Outpatient code editor (OCE) webpage -- provides an overview about the 'Integrated' Outpatient Code Editor (I/OCE).
- Hospital outpatient prospective payment system (OPPS) webpage -- discusses the authority for CMS to implement OPPS under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients that have no Part A coverage, and partial hospitalization services furnished by community mental health centers.
- Long-term care hospitals
- Long-term care hospital PPS webpage -- provides an overview and additional information regarding LTCH PPS.
- Long term care hospital prospective payment system MLN educational tool -- provides a detailed overview of the LTCH PPS.
- FY 2023 inpatient and long-term care hospital PPS changes -- MLN Matters (MM) article 12814 implements policy changes for FY 2023 IPPS and LTCH PPS, effective for hospital discharges occurring on or after October 1, 2022, through September 30, 2023, unless otherwise noted.
- FY 2022 inpatient and long-term care hospital PPS changes -- MM12373 implements policy changes for FY 2022 IPPS and LTCH PPS, effective for hospital discharges occurring on or after October 1, 2021, through September 30, 2022, unless otherwise noted.
- Long-term care hospital PPS webpage -- provides an overview and additional information regarding LTCH PPS.
- Swing-bed facilities
- Swing bed providers webpage -- provides an overview and additional information regarding swing bed facilities paid under the skilled nursing facility (SNF) PPS.
- Swing bed services MLN fact sheet -- provides a detailed overview of swing bed services.
- Hospital and CAH swing bed manual revisions -- MM10962 clarifies policies related to hospitals and CAHs with respect to services furnished to swing bed patients, including policies related to pass-through reimbursement for CRNA services.
- Swing bed providers webpage -- provides an overview and additional information regarding swing bed facilities paid under the skilled nursing facility (SNF) PPS.
- Teaching hospitals
- Transplant centers
- Bypassing payment window edits for donor post-kidney transplant complication services -- MM11312 directs MACs to implement logic ensuring they bypass payment window edits (three-day and 1-day) when processing claims for donor post-kidney transplant complications services.
- CMS Certification & Compliance for Transplant programs
- Beneficiary notices -- Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Medicare program. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers.
- Clinical Laboratory Improvement Amendments (CLIA) webpage -- Congress passed the CLIA in 1988 establishing quality standards for all laboratories testing to ensure the accuracy, reliability and timeliness of patient test results, regardless of where the test was performed. The CLIA regulations are based on the complexity of the test method; thus, the more complicated the test, the more stringent the requirements.
- Clinical trials, approved facilities and registries
- CMS Certification & Compliance
- CMS Conditions for Coverage (CfCs) & Conditions of Participation (CoPs) -- CMS develops these health and safety standards that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs.
- Office of Inspector General (OIG) reports highlight hospital billing issues -- special edition article releases information regarding OIG reports, which focused on claims for right heart catheterizations with heart biopsies that used modifier 59 and claims for 96 or more continuous hours of mechanical ventilation.
- Quality incentives and innovation models
- Hospital-Acquired Condition Reduction Program (HACRP)
- Hospital Quality Initiative -- links to CMS hospital quality reporting programs for inpatient and outpatient facilities.
- Hospital Readmissions Reduction Program (HRRP) -- Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions.
- LTCH QRP -- provides important announcements and updates regarding the LTCH QRP.
- Innovation Models -- The Innovation Center develops new payment and service delivery models in accordance with requirements of the Social Security Act. This link provides information on several specific demonstrations being conducted by CMS.
- Special open door forums hosted by CMS
Professional associations
- American Association of Healthcare Administrative Management (AAHAM)
- American Case Management Association (ACMA)
- American Health Care Association (AHCA)
- American Health Information Management Association (AHIMA)
- American Hospital Association (AHA)
- American Medical Association (AMA)
- Association for Community Health Improvement (ACHI)
- Association for Healthcare Resource & Materials Management (AHRMM)
- Association for the Healthcare Environment (AHE)
- Florida Health Care Association (FHCA)
- Florida Hospital Association (FHA)
- Florida Medical Association (FMA)
- Florida Society for Risk Management and Patient Safety (FSHRMPS)
- Health Care Administrators Association (HCAA)
- Health Care Compliance Association (HCCA)
- Healthcare Financial Management Association (HFMA)
- Healthcare Information and Management Systems Society (HIMSS)
- Puerto Rico Hospital Association (PRHA)
- Society of Hospital Medicine (SHM)
- South Florida Hospital & Healthcare Association (SFHHA)
General resources
- American Journal of Medicine
- Health Research & Educational Trust (HRET)
- MedWatch -- Food and Drug Administration (FDA) medical recalls
- National Institutes of Health
- PubMed