CMS explains temporary halt of QIO two-midnight reviews

CMS has issued additional information on why it paused Quality Improvement Organization claim audits under the two-midnight inpatient admissions rule last month.

CMS said it instituted the pause May 4 after becoming aware of inconsistencies in the QIOs' application of the two-midnight policy for short hospital stay reviews.

The pause will allow QIOs time to re-review all claims denied since October 2015 to make sure medical review decisions and subsequent provider education are consistent with current policy.

CMS anticipates QIOs will resume audit activities within 60 to 90 days.

Beginning Oct. 1, 2015, QIOs assumed responsibility for conducting initial patient status reviews of providers to determine the appropriateness of Medicare Part A payment for short stay inpatient hospital claims. These reviews were previously conducted by Medicare Administrative Contractors.

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