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January 17, 2019 - Updated 01.28.19

Clarification – Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization' (QIO) Hospital Short Stay (Two-Midnight Rule) Patient Status Reviews

Note: Please share with billing staff and other staff as needed who might benefit from this information.

MLN Matters article MM10600External PDF shared information for admission under the Two Midnight rule for acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities submitting short-stay, inpatient claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

CGS did not adjust claims associated with the QIO's Short Stay Review (SSR) process prior to September 11, 2018. Providers will receive payment for these claims during this time period. Claims received by CGS after September 11, 2018 related to QIO SSR's will be adjusted. A demand letter will be issued once these claims are adjusted. Appeal rights are associated with the issuance of demand letters.

Reference: CMS IOM Pub. 100-20 One-Time Notification, Change Request 10600External PDF

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