CMS has announced that it is allowing Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) to resume initial patient status reviews to determine the appropriateness of Part A payment for short stay inpatient hospital claims, effective September 12, 2016. Such reviews had been "paused" since May 4, 2016 to promote consistent application of medical review policies regarding patient status for short hospital stays. In a web post, CMS explains that it is lifting the review suspension because the BFCC-QIOs: successfully completed re-training on the Two-Midnight policy; completed a re-review of claims that were previously formally denied; and initiated various provider outreach efforts related to this policy. In addition, CMS examined and validated the BFCC-QIOs peer review activities related to their short stay reviews, and the agency will continue monthly re-reviews of a sample of BFCC-QIO completed claim reviews.
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