The CMS fi­nal­ized a mod­i­fied two-mid­night pol­icy Fri­day,

Modern Healthcare - - LATE NEWS - —Vir­gil Dick­son

de­spite ar­gu­ments that the mod­i­fied rule could lead to fraud.

The two-mid­night rule calls for Medi­care’s pay­ment and au­dit con­trac­tors to as­sume a hospi­tal ad­mis­sion was le­git­i­mate if it spans two mid­nights. The agency will al­low doc­tors to ex­er­cise judg­ment in ad­mit­ting pa­tients for short stays. The CMS is re­mov­ing au­dit­ing over­sight from its ad­min­is­tra­tive con­trac­tors and in­stead let­ting qual­ity im­prove­ment or­ga­ni­za­tions (QIOs) en­force the pol­icy. Re­cov­ery au­dit con­trac­tors (RACs) would be di­rected to fo­cus only on hos­pi­tals with un­usu­ally high rates of de­nied claims.

The Amer­i­can Hospi­tal As­so­ci­a­tion said hos­pi­tals “look for­ward” to work­ing with QIOs rather than RACs, and an­tic­i­pate a fairer au­dit­ing process.

The CMS de­nied a re­quest to de­lay en­force­ment, say­ing the Jan.1, 2016 start date was enough time for hos­pi­tals to un­der­stand the fi­nal rule.

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