The Two-Midnight Rule: Changes For 2016

The Two-Midnight Rule: Changes for 2016

  • February 1, 2016

Medical Necessity Documentation Still Required Have you heard the news? In the 2016 Outpatient Prospective Payment System Final Rule the Centers for Medicare & Medicaid Services (CMS) has modified the two-midnight rule evaluation and enforcement process. The “probe and educate” period ends on January 1, 2016. Enforcement of the rule will be the responsibility of the two BFCC Quality Improvement Organizations (Livanta and KEPRO). Their charge is to evaluate the appropriateness of short-stay inpatient admissions that extend over less than two midnights. Both BFCC Quality Improvement Organizations (BFCC-QIOs) will use InterQual as a decision support tool to help evaluate whether…

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Livanta Selects InterQual To Support Its Medicare Utilization And Quality Care Reviews

Livanta Selects InterQual to Support its Medicare Utilization and Quality Care Reviews

  • January 28, 2016

Today we announced that healthcare services company Livanta licensed InterQual after becoming the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for Centers for Medicare & Medicaid Services (CMS) Areas 1 and 5. Livanta signed a long-term agreement to use InterQual for utilization and quality reviews for Medicare beneficiaries, including short-stay inpatient status claims reviews. Livanta is one of only two BFCC-QIOs charged by CMS to audit short-stay claims. Read the news release

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KEPRO Extends Use Of InterQual To Support Clinical Excellence In Utilization And Quality Reviews

KEPRO Extends Use of InterQual to Support Clinical Excellence in Utilization and Quality Reviews

  • January 25, 2016

Today we announced that KEPRO (Keystone Peer Review Organization, Inc.) will continue its use of InterQual for utilization and quality reviews. KEPRO is one of only two Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) charged by the Centers for Medicare & Medicaid Services (CMS) to audit short-stay claims. As part of the new long-term agreement, KEPRO will use InterQual for review of two-midnight short stays on behalf of CMS, in addition to quality reviews for its state Medicaid contracts and commercial lines. Read the news release

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