Confusion persists over how government contractors should apply Medicare’s regulations for determining inpatient status when a hospital stay spans less than two midnights, according to a report from HealthLeaders Media.
Recently, a spokesman for the Centers for Medicare and Medicaid Services (CMS) announced that a temporary suspension of initial reviews for Medicare reimbursement of short-term patient stays in hospitals would continue to the end of July. In early May, the CMS told government contractors to suspend initial reviews of Medicare claims for inpatient stays shorter than a span of two midnights.
Under the CMS’ two-midnight rule, established in 2013, most hospital stays lasting fewer than two midnights are considered inappropriate for an “inpatient” designation and are ineligible for Medicare Part A reimbursement.
Last October, the CMS announced that initial reviews of the rule would be transferred from recovery audit contractors to Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs). On June 6, the CMS ordered BFCC-QIO contractors to re-examine “all claims they denied in their medical review process since October 2015 to make sure medical review decisions and subsequent provider education are consistent with current policy. The current 'pause' will allow time for the BFCC-QIOs to conduct these re-reviews.”
According to Ronald Hirsh, MD, FACP, vice president of Accretive Health's regulations and education group, hospitals need to understand seven key points about the two-midnight rule:
Source: HealthLeaders Media; June 7, 2016.