CMS pauses two-midnight rule reviews

CMS said it will pause reviews under the two-midnight rule temporarily to improve standardization across its Quality Improvement Organization Program.

QIOs — groups of health quality experts, clinicians and consumers who work under direction of CMS — last year conducted initial patient status reviews to determine the appropriateness of Medicare Part A payment for short-stay inpatient hospital claims. These first-line medical reviews were previously conducted by Recovery Audit Contractors or Medicare Administrative Contractors.    

In January, QIOs and recovery auditors began conducting patient status reviews in accordance with any policy changes finalized in the 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule and effective in calendar year 2016.

CMS expects to release more details soon.


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