CMS Issues FAQs on Inpatient Admision and Medical Review Criteria

On September 26, 2013, the Centers for Medicare and Medicaid Services (CMS) issued guidance on the fiscal year 2014 hospital inpatient prospective payment system final rule. In the FAQ document, CMS answers the following questions:

Will CMS direct the Medicare review contractors to apply the 2-midnight presumption-that is, contractors should not select inpatient claims for review if the inpatient stay spanned two midnights from the time of admission?

Will Medicare contractors base their review of the physician’s expectation of medically necessary care surpassing 2 midnights upon the information available to the admitting practitioner at the time of admission?

What steps will CMS take to provide guidance and education about the inpatient rule, to ensure hospital understanding and compliance with the revised instruction?

To view the answers, click