QIOs resume two-midnight reviews

Quality Improvement Organizations today resumed claim audits under the two-midnight inpatient admissions policy, the Centers for Medicare & Medicaid Services announced. CMS temporarily paused the patient status reviews in May to improve standardization after AHA shared with the agency hospitals’ concerns about the review process. CMS said it was lifting the pause in reviews because the Beneficiary and Family Centered Care QIOs have completed re-training on the two-midnight policy; re-reviewed claims that were previously formally denied; performed provider outreach on claims affected by the temporary suspension; and initiated provider outreach and education regarding the two-midnight policy. In addition, CMS said it examined and validated the BFCC-QIOs’ peer review activities related to short-stay reviews and will continue to review a sample of completed claim reviews each month, monitor provider education calls, and respond to individual provider inquiries and concerns. Questions and comments about the reviews may be submitted to CMS at ODF@cms.hhs.gov.