CMS releases final 2014 inpatient hospital rule

The Centers for Medicare & Medicaid Services (CMS) has released the final rule covering inpatient hospital services for the 2014 fiscal year, which starts on Oct. 1, 2013. This wide-ranging rule covers many areas, including those that may be relevant for cardiovascular professionals.

Highlights of the rule include:

  • Hospital payments will increase by 0.7 percent, reflecting an increase based on the hospital market basket measure of inflation but reduced by other factors.
  • Hospital services that span less than two midnights shall be assumed to be observation without significant medical documentation that indicates that the service should be paid under the inpatient system. Similarly, services that last longer than two midnights shall generally be considered inpatient services. Medical necessity must still be documented. The American College of Cardiology (ACC) is hopeful that this new guidance will make it more clear which patients are outpatient and which are inpatient. In a related provision, hospitals will now be able to bill for many services that would have been covered under Medicare Part B if the service is denied as an inpatient claim. However, claims must still be filed within one year, so claims denied under recovery audit contractor reviews or other auditing functions may not be able to be refilled as Medicare Part B claims.
  • Technical payment changes will increase payments for services that include implantable devices, particularly implantable cardioverter-defibrillator  implantations. The technical change is related to the establishment of new cost centers for implantable devices, CT, MR and cardiac catheterization services and relate to the way that costs are accounted for and categorized within the hospital payment system. This change also affects other services provided in cardiovascular medicine, but not by a great amount. Services that include a substantial amount of CT or MR will have their payments reduced substantially by this proposal, but no inpatient cardiovascular services fall into this category.

Additional highlights of the rule are available on