The Centers for Medicare & Medicaid Services has temporarily halted audits of short-term hospitals admissions under the controversial two-midnight rule.
The rule, which was finalized as part of the 2016 physician fee schedule last November, requires patients to be in a hospital for at last two midnights before they qualify as an inpatient. Organizations that review the “appropriateness” of hospital stays shorter than two midnights were instructed by CMS to temporarily stop their audits earlier this month, Bloomberg BNA reported on Friday.
An unnamed CMS official confirmed to Bloomberg that the agency has told Medicare Quality Improvement Organizations to halt their reviews in order to “improve standardization across the QIO program.” While the length of the audit freeze isn’t known, the CMS official added that more details would be forthcoming.
The freeze follows changes included in the final two-midnight rule that allow inpatient admissions lasting less than two-midnights to be covered by Medicare on a “case-to-case” basis. These inpatient status reviews — previously conducted by recovery audit contractors — were taken up by QIOs in November.
Melissa Jackson, senior associate director for policy at the American Hospital Association, told Bloomberg that the pause on new audits will allow QIOs to catch up with new requirements included in the updated rule, and give the QIOs, CMS and providers time to assess the first round of audits.
