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AHA urges changes to proposed inpatient payment rule

June 20, 2013

The AHA today urged the Centers for Medicare & Medicaid Services to revise its proposed rule for the inpatient prospective payment system for fiscal year 2014 expressing concerns regarding its disproportionate share hospital and Hospital-acquired Condition Reduction Program proposals, as well as the proposed handling of electronic quality measure data collection within the Inpatient Quality Reporting program. AHA yesterday sent CMS a separate letter urging the agency to issue new instructions to its recovery audit and other contractors explaining how to review the medical necessity of Medicare Part A inpatient hospital stays, instead of finalizing its proposed “time-based presumption” policy. Proposed in the FY 2014 inpatient PPS rule issued in May, the policy would instruct Medicare medical review contractors to presume an inpatient hospital admission is reasonable and medically necessary if a beneficiary requires more than one Medicare utilization day, which the agency defines as an encounter crossing two midnights. The association encourages hospital leaders to submit their own comments to CMS by the June 25 deadline, using the AHA letters as models.