News & Analysis as of

QIOs

Medicare Two-Midnight Rule and Observation Status Updates

by Baker Ober Health Law on

What's new from Medicare in the areas of the Two-Midnight rule and observation services? CMS recently published updates to a Medicare manual reflecting clarifications to its Two-Midnight policy, a Medicare Quality Improvement...more

CMS Ends Temporary Suspension of Hospital “Two-Midnight” Short Stay Reviews

by Reed Smith on

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...more

Also In The News - Health Headlines - August 2016

by King & Spalding on

CMS Provides Update Regarding Patient Status Review Delay – On July 27, 2016 CMS posted an update regarding Quality Improvement Organization (QIO) reviews of patient status claims, which are currently paused. CMS notes that...more

CMS Update on Temporary “Two Midnight” QIO Review Pause

by Reed Smith on

CMS has temporarily “paused” Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) performance of initial patient status reviews under CMS’s “two-midnight policy” for short hospital stays. The...more

CMS Announces "Pause" in QIO Review of Inpatient Admissions

by Baker Ober Health Law on

Last week CMS announced a temporary "pause" in the review of inpatient admissions by the Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs). CMS posted this announcement on its Inpatient Hospital...more

CMS Finalizes Significant Changes to the Two Midnight Rule in the 2016 OPPS Final Rule

by King & Spalding on

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2016 Outpatient Prospective Payment System Final Rule (2016 OPPS Final Rule). In the 2016 OPPS Final Rule, CMS finalizes...more

Also In The News - Health Headlines - October 2015 #4

by King & Spalding on

Quality Improvement Organization Releases Guidance on Short-Stay Reviews – As previously reported, in July 2015, CMS announced that Quality Improvement Organizations (QIOs) would begin conducting reviews of certain inpatient ...more

CMS Updates Inpatient Hospital “Two Midnight” Review Education/Enforcement Strategy

by Reed Smith on

CMS recently provided an update on its education and enforcement strategies related to its “Two Midnight” policy, which addresses when surgical procedures, diagnostic tests and other treatments are generally considered...more

Another Delay for the Two-Midnight Rule

by Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) announced, on August 12, 2015, that it has extended the enforcement delay of the controversial two-midnight rule governing short hospital stays until the end of the year....more

Cinderella May Not Turn Into a Pumpkin After All: The Proposed Relaxation of the Two-Midnight Rule

by K&L Gates LLP on

On July 8, 2015, the Centers for Medicare and Medicaid Services (“CMS”) released a Proposed Rule regarding the 2016 Hospital Outpatient Prospective Payment System (“OPPS”). The Proposed Rule, in addition to proposing updates...more

CMS Proposes Limited Exception to Two-Midnight Rule and QIO Review of Short Stays

by Baker Ober Health Law on

In the 2016 inpatient prospective payment system (IPPS) proposed rule, CMS promised to provide further guidance on the controversial "two midnight" rule in the forthcoming outpatient prospective payment system (OPPS) rule....more

Also In The News - Health Headlines - July 2015 #2

by King & Spalding on

CMS and AMA Announce Efforts to Help Providers Get Ready for ICD-10 – On July 6, 2015, CMS and AMA announced efforts to continue to assist providers to get ready for the upcoming October 1 switch from ICD-9 to ICD-10 coding...more

CMS Releases CY 2016 Proposed Rule on OPPS and ASC Payment Systems, Including Changes to the Two Midnight Rule

by King & Spalding on

On July 1, 2015, CMS released a Proposed Rule that would revise the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System payment rates for calendar year (CY) 2016, and would...more

CMS Releases CY 2016 OPPS Proposed Rule With Updates to Two-Midnight Rule and Other IPPS Proposals

by BakerHostetler on

On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2016 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) payment system proposed rule that...more

CMS Proposes to Modify—but Continues to Stand Behind—its “Two-Midnight” Rule

The “Two-Midnight” rule is a Centers for Medicare and Medicaid Services (“CMS”) billing policy which bases the appropriateness of payments for inpatient services under Medicare Part A versus Part B on provider expectations...more

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