Health Information Management

The 2014 IPPS final rule: A closer look at inpatient status criteria

HIM-HIPAA Insider, November 18, 2013

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The 2014 IPPS final rule brought significant changes to inpatient status criteria and Medicare Part B inpatient billing. HCPro's September 10 audio conference "2014 IPPS Final Rule Explained" addressed these changes and more. The final rule clarified the requirements for inpatient orders and physician certification and redefined the criteria for inpatient admission by implementing the "2-midnight" rule. CMS designed the rule to address concerns about long outpatient hospital stays for Medicare beneficiaries, according to an August 15 CMS Open Door Forum call.

The physician order is the first element of the certification process. Under the IPPS final rule, a physician order is required at or before the time of admission for inpatient status assignment. "That order is the thing that will start an inpatient admission," said Kimberly ­Anderwood Hoy Baker, JD, CPC, director of Medicare compliance for HCPro, who spoke during the audio conference. "You don't have an inpatient admission if you don't have an inpatient order."

Pay attention to the language on physician orders and review order sets for accuracy, Baker said. Physician orders must now include the word "inpatient," she added. The final rule expanded the physician order criteria to allow qualified and licensed practitioners with ­admitting privileges at the hospital to write inpatient orders. The practitioner does not need to be the physician in charge of the patient's care but must be knowledgeable about the patient's hospital course, medical plan of care, and current condition, Baker said.

Listen to HCPro's "2014 IPPS Final Rule Explained" audio conference on demand at

For clarification on Part B rebilling and the 2-midnight benchmark and presumption, continue reading "The 2014 IPPS final rule: A closer look at inpatient status criteria" on the HCPro website. Subscribers to Medical Records Briefing have free access to this article in the November issue.

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