CMS: RACs to delay scrutiny of short inpatient stays

Only days after more than 100 members of the House of Representatives urged the Centers for Medicare & Medicaid Services to postpone its "two-midnight" rule for hospital inpatient admissions set to take effect Oct. 1, CMS issued guidance on the new policy and announced auditors will delay scrutiny of short inpatient stays for 90 days.

In the guidance, the agency restated that Medicare administrative contractors (MACs) and recovery auditors (RACs) are not to review claims spanning more than two midnights after admission to determine appropriate inpatient status for a medically necessary claim. Moreover, for 90 days, CMS will not allow RACs to review inpatient admissions of one midnight or less that begin on or after Oct. 1.

During that period, MACs and RACs also will not review claims related to critical access hospitals.

To test whether hospitals understand the revised inpatient rule and show their compliance, MACs will review small samples of inpatient hospital claims spanning less than two midnights with admission dates of Oct. 1 through Dec. 31, 2013 to determine appropriateness of patient status. The probe also will help CMS develop further education and guidance.

While medical review won't focus on claims spanning more than two midnights, CMS reminds hospitals that physicians should make admissions decisions consistent with the two-midnight rule.

"If at any time there is evidence of systematic gaming, abuse or delays in the provision of care in an attempt to surpass the 2-midnight presumption could warrant medical review," CMS stated in the guidance.

Despite the clarifications and 90-day delay, the American Hospital Association isn't satisfied and called the agency's attempt a failure. The hospital group still wants CMS to suspend the rule and work on a new policy altogether. "Unfortunately, the agency's guidance only raises new questions and lacks clarity," AHA President and CEO Rich Umbdenstock said Thursday in a statement. "Hospitals do not support the implementation of this regulation under these circumstances--too many aspects are fundamentally flawed."

Other industry leaders, including the likes of Don Berwick, M.D., former CMS administrator, and a Harvard Medical School-affiliated geriatrician, also disapprove of the rule.

For more:
- here's the CMS guidance (.pdf)
- read the AHA statement (.pdf)

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