CMS pauses QIO two-midnight reviews

The Centers for Medicare & Medicaid Services has temporarily paused two-midnight patient status reviews to improve standardization across the program, the agency last week told the Quality Improvement Organizations conducting the reviews. CMS plans to work with the QIOs during the pause to ensure the two-midnight policy is consistently applied in the reviews. AHA staff recently shared with CMS hospitals’ concerns about the QIO review process. These include insufficient time to implement education and improvement activities between a first-round audit and second audit request; and delayed receipt of review results and education, which could prevent the hospital from rebilling denied claims under Part B due to the one-year filing limit. CMS told AHA it plans to provide additional information on process improvements and educational tools for the two-midnight policy in the coming weeks.