Suspension of Two-Midnight Rule Reviews Could Last Through July
Confusion persists over how government contractors should apply Medicare's regulations for determining inpatient status when a hospital stay spans less than two midnights.
A temporary suspension of initial reviews for Medicare reimbursement of short-term patient stays in hospitals could stretch through the end of July, a CMS spokesperson said Tuesday.
In the latest twist of the so-called two-midnight rule's course toward full implementation, the Centers for Medicare & Medicaid Services told government contractors early last month to suspend initial reviews of Medicare claims for inpatient stays shorter than a span of two midnights.
Under the rule, which has been in place since October 2013 and was significantly revised in October 2015, most hospital stays spanning a period of less than two midnights are considered inappropriate for designation as inpatient status and are ineligible for Medicare A reimbursement.
Last October, CMS announced that initial two-midnight rule reviews would be shifted from Recovery Audit Contractors to Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs).
Two companies were contracted to conduct the reviews: Annapolis Junction, MD-based Livanta and Harrisburg, PA-based KEPRO.