Inpatient Hospital Services Billing, Denials and Reimbursement: Evolving Regulatory and Legal Landscape

Navigating the Interplay of Inpatient and Outpatient Hospitalization Requirements to Withstand Audits and Pursue Appeals

Recording of a 90-minute CLE webinar with Q&A


Conducted on Tuesday, February 25, 2014

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will provide guidance to hospital counsel on the regulatory and CMS policy changes related to inpatient billing and the impact on reimbursement. The panel will provide guidance on how hospitals can meet the new requirements, withstand anticipated audits and pursue appeals.

Description

The regulatory and legal landscape related to billing and reimbursement of short stay inpatient hospital claims has evolved. Hospitals are under heightened scrutiny and have seen an increased number of audits being conducted. Hospitals face the challenge of meeting CMS requirements and avoid denials of reimbursement.

CMS changed its long-established payment denial policy and proposed changes to revise its Medicare Part B billing policies in March 2013. Counsel must understand the interplay of the requirements for inpatient admissions and outpatient hospitalizations and the implications for reimbursement.

As hospitals adapt to the evolving landscape, counsel plays a critical role in shaping policies and providing guidance so that hospitals are in the best position to survive audits and successfully pursue appeals.

Listen as our authoritative panel of healthcare attorneys discusses the recent changes to federal regulations and CMS policy related to billing for inpatient admissions and inpatient claim appeals, which will impact hospitals’ decisions regarding whether to admit patients as “inpatients” and potentially impact reimbursement. The panel will provide guidance on how hospitals can meet the new requirements, withstand anticipated audits and pursue appeals.

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Outline

  1. Recent changes to federal regulations and CMS policy related to billing for inpatient admissions and claim appeals
  2. Inpatient admissions vs. outpatient hospitalization services—billing and appeals
  3. Guidance on meeting new requirements and withstanding anticipated audits and pursuing appeals

Benefits

The panel will review these and other key questions:

  • What are the recent changes to federal regulations and CMS policies related to inpatient billing?
  • How do the regulatory and CMS policy changes impact hospitals' policies and determination concerning inpatient admission and reimbursement?
  • What steps can counsel take to ensure hospitals meet the new requirements, withstand anticipated audits and successfully pursue appeals?

Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.

Faculty

Jessica Gustafson
Jessica Gustafson

Founding Partner
The Health Law Partners

Ms. Gustafson practices in all areas of health care law and devotes a substantial portion of her practice to...  |  Read More

Abby Pendleton
Abby Pendleton

Founding Partner
The Health Law Partners

Ms. Pendleton provides counsel to healthcare providers and organizations in a number of areas, including but not...  |  Read More

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