The Centers for Medicare & Medicaid Services has temporarily suspended short-stay inpatient payment reviews by the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) due to issues regarding the interpretation of the two-midnight stay policy.
CMS did not reveal the interpretation issue, but said a review indicated that the problem had been going on for at least six months.
“CMS became aware of inconsistencies in the BFCC-QIOs’ application of the two-midnight policy for short hospital-stay reviews, and on May 4, 2016, we temporarily paused short-stay patient status reviews to give us time to improve standardization in the BFCC-QIOs’ review process,” the CMS said in a statement. “CMS is requiring the BFCC-QIOs to re-review 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."
CMS said it believes the reviews for short stays would resume within 60 to 90 days, but only after “the BFCC-QIOs have completed retraining on the two-midnight policy, completed the re-review of previously denied claims, and performed any needed provider outreach and education.”
The two-midnight rule has been a sore point for hospitals because patients who are hospitalized for a shorter length of time are considered outpatients. The hospital sector sued over the rule as it was being promulgated and afterward as well. As the number of inpatient stays has increased since the rule has been clarified, CMS has tried to reduce payments, resulting in a lawsuit filed earlier this year by 55 hospitals. The agency backed off on the cuts last spring.
To learn more:
- read the CMS statement
Related Articles:
More than 50 hospitals sue CMS over two-midnight rule cuts
CMS proposed inpatient payment rule rolls back two-midnight rule cuts