News: Three-month delay in patient status reviews related to new 'two-midnight' policy
CDI Strategies, November 7, 2013
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CMS will not conduct post-payment patient status reviews for admission dated October 1, 2013 through March 31, 2014—a three-month delay from previous recommendations, the AHA News Now reported this week.
However, CMS did instruct its Medicare Administrative Contractors to review a small sample of inpatient hospital claims spanning less than two midnights after admission to determine for medical necessity of the patient status in accordance with the two midnight benchmark, CMS said in its frequently asked question document released November 1.
“This probe sample will determine each hospital's compliance with the new inpatient rule and provide important feedback to CMS for purposes of jointly developing further education and guidance,” CMS states.
Although reviews won’t be focused on the two-midnight rule, CMS made a point to emphasize that physicians need to follow the new provisions and that any evidence of “systematic gaming, abuse, or delays in the provision... in an attempt to surpass the [new rule] could warrant medical review.”
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