ICD10monitor January 31, 2024
When the Centers for Medicare & Medicaid Services (CMS) formalized CMS-4201-F with an effective date of Jan. 1, 2024, there was great relief within the utilization review (UR) community, as this rule requires Medicare Advantage (MA) plans to follow the provisions of 42 CFR § 412.3, the Two-Midnight Rule.
Included within that section of the Federal Register is the provision at 42 CFR § 412.3 (d)(2) that the Inpatient-Only List (IPO) also must be honored by MA plans. In other words, they can no longer deny inpatient admission for patients undergoing a surgery whose HCPCS code is included on Addendum E of the yearly Outpatient Prospective Payment System (OPPS) Final Rule. They also are required to follow the case-by-case exception...
Today's Sponsors
Today's Sponsor