CMS Revises Short Stay Hospital Claims Guidelines

CMS has revised guidelines on “Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After January 1, 2016.” Starting October 1, 2015 Beneficiary and Family Centered Care Quality Improvement Organizations began conducting initial patient status reviews of claims for inpatient admissions. Under the revised exceptions policy (CMS-1633-F), which became effective January 1, 2016, for admissions not meeting the two midnight benchmark, Part A payment may be appropriate on a case-by-case basis where the medical record supports the admitting physician’s determination that the patient requires inpatient care, despite the lack of a 2 midnight expectation. Full story.