CMS has temporarily "paused" Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations' (QIOs) performance of initial patient status reviews under CMS's "two-midnight policy" for short hospital stays. The pause, which took effect May 4, 2016, was a result of inconsistencies in the BFCC-QIOs' application of the two-midnight policy and was intended to give CMS time to standardize the BFCC-QIO review process. CMS expects BFCC–QIOs reviews to resume within a few months. CMS also has announced that beginning June 6, 2016, BFCC-QIOs must re-review all short stay patient status claims that were denied under the QIO medical review process. CMS requests that hospitals determine if their denied claims have been re-reviewed by their BFCC-QIO before appealing such a claim denial. Furthermore, a "Policy Decision Guideline flowchart" that will be used to guide the payment decision process is available here.
This article is presented for informational purposes only and is not intended to constitute legal advice.
