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Suspension of Two-Midnight Rule Reviews Could Last Through July

By Christopher Cheney  
   June 08, 2016

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.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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