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CMS orders review of ‘two-midnight’ denied claims
e-Reports, March 10, 2014
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The Centers for Medicare & Medicaid Services (CMS) has ordered an audit of inpatient claims denied under the two-midnight rule since Oct. 1.

The controversial policy established that inpatient hospital stays not lasting through two midnights would be paid as outpatient services. A stay longer than two midnights would qualify for Medicare Part A reimbursement.

Both physicians and hospitals reported the rule has been difficult to implement – and apparently that is true for Medicare contractors as well. CMS called for the audit after revealing that claims may have been denied based on reasons not current with the new rule. Thus, the CMS ordered reviews that will be handled outside the normal appeals process.

Modern Healthcare reported that contractors have requested 29,000 medical records, 6,000 of which have been “re-reviewed.”

This development comes about three weeks after the CMS announced a delay in enforcement of the rule.

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