Quality Improvement Organizations resume two-midnight reviews

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Beneficiary and Family Centered Care Quality Improvement Organizations resumed two-midnight rule claim audits Monday after CMS temporarily paused the reviews in May.

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 gave 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.

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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