The Centers for Medicare and Medicaid Services (“CMS”) announced that as of September 12th CMS lifted the temporary suspension of short stays review by Beneficiary and Family Centered Care Quality Improvement Organizations (“QIOs”). QIOs will resume the review of initial patient status of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Part A payment for short stay hospital claims.
CMS temporarily suspended the QIOs’ review of initial patient status for short stays on May 4, 2016 as the agency became aware of inconsistencies in how the QIOs applied the two-midnight rule. CMS determined that the suspension was warranted in order to promote consistent application of the rule and to improve standardization in the QIOs’ review process.
CMS lifted the temporary suspension because QIOs:
- Successfully completed re-training of the two-midnight rule
- Completed a re-review of claims previously denied
- Conducted provider outreach on the impacted claims
- Initiated provider outreach and education regarding the two-midnight rule
CMS will continue to provide oversight by re-reviewing a sample of the QIOs’ completed claim review each month, monitoring provider education calls and responding to provider inquires and concerns. Providers can send questions to the CMS Open Door Forum Mailbox at ODF@cms.hhs.gov
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