Centers for Medicare & Medicaid Services

CMS issues revised guidelines for ‘two-midnight’ rule.

The Centers for Medicare & Medicaid Services (CMS) on January 1 issued revised guidelines on “Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After January 1, 2016.”

Under the revised exceptions policy 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 physician’s determination that the patient requires inpatient status, despite the lack of a two-midnight expectation.

CMS will consider complex medical factors such as history and comorbidities, the severity of signs and symptoms, current medical needs, and the risk of an adverse event to determine whether the medical record supports the need for inpatient hospital care.

http://qioprogram.org/sites/default/files/20160105-Reviewing%20Short%20Stay%20Hospital%20Claims%20for%20Patient%20Status%20Final.pdf
CMS announces ASC quality reporting appeals process. The Centers for Medicare & Medicaid Services (CMS) on December 16 announced that ambulatory surgery centers (ASCs) subject to a reduction in Medicare outpatient payments in CY 2016 because of noncompliance with the ASC quality reporting program may submit a request for reconsideration by March 17, 2016.

ASCs not meeting all requirements of the program or participating in the program will receive a 2% reduction of annual payment updates.

https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1228773653434