Inpatient reimbursement alerts

This one-time notification (CR 14553) targets A/B MACs Part A and the Fiscal Intermediary Shared System (FISS), with an implementation date of January 4, 2027. The transmittal subject is truncated, so

This transmittal (CR 14457) extends the default recoupment date for Part A cost report overpayments and revises related processes, effective January 4, 2027. Billing teams at Part A providers (hospita

This transmittal implements the annual IRF PPS update effective for services on or after October 1, 2026 (FY2027). Billing teams must ensure claims processing systems are updated by October 5, 2026 to

This transmittal implements FY 2027 MS-DRG updates effective October 5, 2026, impacting inpatient hospital claims processing. Billing teams must update their grouper software and charge description ma

CMS finalizes FY2027 IPPS and LTCH PPS payment rates effective October 1, 2026, revising operating and capital payment systems for acute care hospitals and long-term care hospitals. The rule updates G

This transmittal adjusts the hourly salary equivalency amount and monthly inflation factors for Critical Access Hospitals (CAHs). Billing teams at CAHs should review updated cost report calculations a

CMS finalizes IRF PPS payment rates for FY 2027 (effective October 1, 2026), including updated case-mix group weights and completion of the 3-year rural adjustment phaseout. Key operational changes in

CMS finalizes FY 2027 IPF PPS rate updates effective October 1, 2026, including revised prospective payment rates, updated wage index, and refined outlier threshold policies for psychiatric hospitals

This active final LCD from Wellpoint Federal governs coverage criteria for psychiatric inpatient hospitalization under both Part A and Part B, effective April 1, 2026. It establishes the medical neces

CMS is expanding the Supplemental Security Income (SSI) ratio data used in the Inpatient Provider Specific File, with implementation effective July 4, 2027. This change affects how SSI ratios are calc

CMS is implementing the FY 2027 annual update to the Medicare Code Editor (MCE) and ICD-10 code sets, effective October 5, 2026. Billing teams must update their claim editing systems and encoders to r

This transmittal implements CR 14262, directing systems to send Transplant Program Hospital Type and new organ type data to Fiscal Intermediaries/MACs. Billing teams should verify that transplant prog

This transmittal implements editing for Programs of All-Inclusive Care for the Elderly (PACE) inpatient claims, effective April 6, 2026. Billing teams should review PACE inpatient claim submissions to

This transmittal updates Chapter 40 of the Provider Reimbursement Manual, which governs the Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552). Billing and cost reporting teams shou

The correction of a typographical error in the Medicare proposed rule could have minimal impact on billing and reimbursement processes for hospitals. However, providers should stay informed about any

The recent court decision has led to significant revisions in the Medicare wage index values for FY 2025, which will impact inpatient hospital reimbursement rates. Hospitals, especially low wage ones,

The recent correction in the final rule for the Hospital Inpatient Prospective Payment Systems (IPPS) may affect reimbursement rates for acute care and long-term care hospitals. These adjustments, alo

The announcement of the inpatient hospital deductible and coinsurance amounts for CY 2026 will directly impact hospital billing processes and patient reimbursement calculations under Medicare Part A.

The updated inpatient hospital deductible for CY 2025 will be set at $1,676, which may impact hospital revenue cycles and patient billing. Daily coinsurance rates for inpatient and skilled nursing ser

Starting January 1, 2024, the inpatient hospital deductible will increase to $1,632, impacting hospital reimbursement rates. Additionally, the updated coinsurance rates will apply for extended care se

The proposed rule correction addresses technical errors impacting billing clarity for Medicare and Medicaid reimbursement processes, particularly pertaining to the Inpatient Prospective Payment System

The proposed changes to the inpatient psychiatric facilities payment system will impact the reimbursement rates, potentially increasing revenue for psychiatric services. Additionally, updates to the o

The proposed updates to the IRF prospective payment system for FY 2027 will directly impact reimbursement rates and compliance requirements for inpatient rehabilitation facilities. Key changes include

The upcoming town hall meeting presents a critical opportunity for stakeholders to discuss the implications of new technology add-on payments under the IPPS. The outcomes of this meeting could signifi

The proposed update to the Inpatient Rehabilitation Facility prospective payment system for FY 2026 may lead to significant changes in reimbursement rates, affecting how IRFs manage their billing prac

The announcement of a town hall meeting regarding the FY 2026 applications for new medical services and technologies under IPPS may influence reimbursement rates as hospitals seek to incorporate these

The proposed updates to the Inpatient Rehabilitation Facility (IRF) payment system for FY 2025 may significantly impact billing and reimbursement for IRFs. Changes in case-mix group classifications, w

The recent corrections to the FY 2024 IPPS/LTCH PPS final rule ensure accurate implementation of payment systems, which may affect reimbursement rates for acute care hospitals and long-term care facil

The town hall meeting provides an opportunity for stakeholders to influence the FY 2025 add-on payments under IPPS. Engaging in this dialogue can impact reimbursement rates for new medical services an

The proposed rule aims to revise payment rates and policies for acute care hospitals and long-term care hospitals, which could significantly impact reimbursement structures for inpatient services. Cha

The upcoming changes to the Inpatient Psychiatric Facilities (IPF) payment rates will impact billing processes as the adjustments will affect reimbursement for services provided in these facilities. T

The final rule for the FY 2026 Inpatient Rehabilitation Facility Prospective Payment System introduces updated payment rates that may affect reimbursement levels for rehabilitation services. The conti

The final rule for FY 2026 updates the Hospital Inpatient Prospective Payment System, impacting reimbursement rates for acute care and long-term care hospitals. With revisions due to legal decisions a

The proposed rule for FY 2026 aims to adjust payment rates and factors for Inpatient Psychiatric Facilities, impacting reimbursement models for psychiatric care. The changes will provide updates to wa

The proposed rule outlines significant updates to the Medicare inpatient prospective payment systems, which will directly impact the reimbursement rates for acute care hospitals and long-term care hos

The implementation of an appeals process for Medicare beneficiaries reclassified from inpatient to outpatient status may lead to increased administrative burdens for providers who must navigate new bi

The correction to the FY 2025 IPPS/LTCH PPS final rule will have minimal impact on billing and reimbursement as it primarily addresses technical and typographical errors. Providers should remain aware

The new rule introduces revisions to the Medicare inpatient prospective payment systems, directly impacting reimbursement rates for acute care hospitals. Updates to payment policies for long-term care

The recent updates to the Medicare payment rates for inpatient psychiatric facilities will affect reimbursement levels for fiscal year 2025. Facilities will need to adjust their billing practices due

The updated prospective payment rates for inpatient rehabilitation facilities (IRFs) will impact reimbursement starting October 1, 2024. Key changes include the case-mix group adjustments and shifts i

The proposed rule aims to revise payment systems for acute care hospitals, impacting the reimbursement strategies for both Medicare and long-term care hospitals. It emphasizes adjustments in operating

The proposed updates to the Inpatient Psychiatric Facilities Prospective Payment System for FY 2025 may lead to adjustments in reimbursement rates, outlier thresholds, and wage indexes for services. T

The proposed rule aims to enhance appeal rights for Medicare beneficiaries reclassified from inpatient to outpatient status during their hospital stay. If implemented, it may lead to increased scrutin

The new Medicare rule establishes updated payment structures for hospital inpatient care, impacting reimbursement rates for acute care and long-term care hospitals. Changes in the calculation of days

The final rule for FY 2024 updates payment rates and thresholds for Inpatient Psychiatric Facilities, which may lead to supports compliance with updated rates for psychiatric services. With the revised market

The updates to the IRF prospective payment rates for FY 2024 will impact reimbursement methodologies, affecting how inpatient rehabilitation facilities bill for services. Providers should be aware of

The proposed rule aims to revise the Medicare inpatient prospective payment system, impacting reimbursement rates for hospitals. Adjustments to operating and capital-related costs may affect how hospi

The proposed rule for FY 2024 is set to update payment rates and thresholds for Inpatient Psychiatric Facilities (IPFs), which can significantly affect reimbursement levels for psychiatric services. T

The proposed rule for FY 2024 outlines updates to the payment rates for inpatient rehabilitation facilities, which could impact reimbursements significantly. The changes, including revised classificat

The proposed rule clarifies the calculation of Medicaid disproportionate share hospital (DSH) payments in light of recent legislative changes. These adjustments may impact hospital reimbursement rates