Health Information Management

2-midnight rule probe and educate status update

HIM-HIPAA Insider, March 10, 2014

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by Jaclyn Fitzgerald, Associate Editor
 
On February 24, CMS released an update on the status of the probe and educate reviews that assess compliance with the 2-midnight rule. Preliminary data revealed that MACs had received 18,110 of the 29,158 records selected for review as of February 7. MACs have completed review of 6,012 records.
 
Currently, MACs are conducting prepayment reviews of inpatient hospital claims that are not believed to be in compliance with the 2-midnight rule. Claims selected for review must have dates of admission on or after October 1, 2013, but before September 30, 2014.
 
Based on claim reviews, the following common denials have been made during the probe and educate review period:
  • Missing or flawed order for inpatient admission
  • Short stay procedures
  • Story stays for medical conditions
  • Physician attestation statements without supporting medical documentation
 
In addition to the probe and educate update, CMS also updated the following documents related to compliance with the 2-midnight rule:

 



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