News: CMS tells contractors to hold off on patient status reviews

CMS announced this week an expected extension of the enforcement delay for Recovery Auditor reviews of patient status related to the 2-mdinight rule through December 2015. The enforcement delay was set to expire September 30.

The agency left itself little choice for an extension when it failed to address the 2-midnight rule in the IPPS rule, which takes effect October 1. Instead, CMS proposed changes in the OPPS rule, which takes effect January 1. 

In the 2016 OPPS proposed rule, CMS proposed that for stays a physician expects to last less than two midnights, it will reimburse an inpatient admission on a case-by-case basis, depending on the judgment of the physician and the documentation justifying the stay. CMS expects short stays for minor surgical procedures or hospital care to be rare and will prioritize these types of admissions for medical review.

Quality Improvement Organizations (QIO) would take over responsibility for educating physicians and enforcing the 2-midnight rule from Recovery Auditors, according to the proposed rule. QIOs would perform these reviews based on the current policies beginning October 1, according to CMS. Beginning January 1, 2016, QIOs and Recovery Auditors will conduct the reviews based on policies in the OPPS final rule.

Editor’s Note: This article originally published in the eNewsletter APC Insider.