Health Information Management

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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