ORDER NOW! Compact Disc:

Getting Paid for Inpatient Psychiatric Medicare Days: Complying with Local Coverage Determinations

Did you know that every Medicare day is potentially at risk for payment denial?  To be paid, hospitals and psychiatric units have long been required to prove that they meet a wide variety of Medicare requirements for inpatient psychiatric services. For the first time ever, fiscal intermediaries around the country have developed “local coverage determinations” (LCDs) for inpatient psychiatric services. LCDs are intended to assist the fiscal intermediary (FI) in determining the medical necessity of the services for which the provider is billing and for which the FI is responsible for paying. Fiscal intermediaries for providers in virtually all states throughout the country have each developed their own inpatient psychiatric LCDs. These LCDs cover such issues as admission and discharge criteria, certification, initial evaluation, plan of treatment, and documentation guidelines. NAPHS has worked with some of the largest FIs (Mutual of Omaha, AdminaStar, AHS) to review and refine their LCDs. Learn from psychiatric experts who have been involved in the development, review, and refinement of inpatient psychiatric LCDs. Learn what you need to do to be informed about LCD requirements from your FI, to participate and comment on LCD development, and to work with your clinical and administrative team to ensure compliance with all Medicare requirements.

Compact Disc:

Get Ready for Medicare Inpatient Psychiatric PPS

A two-hour audio training on compact disc focused on the implications and mechanics of inpatient psychiatric PPS for behavioral healthcare organizations. Starting January 1, 2005, a new prospective payment reimbursement system takes effect for behavioral healthcare providers offering inpatient psychiatric services beneficiaries under the Medicare program. A final rule outlining the system appears in the November 15, 2004, Federal Register. You will need to fully evaluate your current financial and clinical operations and make appropriate changes to address the new payment system. The compact disc summarizes the key elements of the final PPS rule, helps you understand the financial implications of the final rule, and discusses ways to improve the efficiency and lower the costs of your clinical programming.

  • Compact disc order form (.pdf)
  • Biographies of faculty
  • Objectives
  • Final rule on inpatient psychiatric PPS (in the November 15, 2004, Federal Register under Centers for Medicare and Medicaid Services) . 95 pages. Please allow time for file to open.
  • CMS Web pages on inpatient psychiatric PPS

NAPHS Members Only:  "A Toolkit for Action: Transitioning Your Organization to the Medicare Inpatient Psychiatric Prospective Payment System" (based on the final rule). Requires member password. See 1/05.

Preparing Your Organization for Medicare Conditions of Participation Surveys

Psychiatric hospitals and psychiatric units that accept Medicare and Medicaid patients must comply with federal "Conditions of Participation" and are subject to survey on these conditions. The conditions cover a wide range of issues, focusing on staffing, medical record documentation, and patient rights (including restraint/seclusion). For staff members working within the inpatient setting, it is essential to fully understand the requirements and to be able to effectively assess and monitor compliance. Get help with:

The Medicare Outpatient Prospective Payment System

As of August 1, 2000 Medicare moved to a totally new method of reimbursement - an outpatient prospective payment system (OPPS) - for partial hospitalization and other outpatient services provided by Medicare hospitals. Get help with:

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