CHA News Article

CMS Issues Additional Information on QIO Two-Midnight Review Pause

The Centers for Medicare & Medicaid Services has issued additional information on its temporary pause of quality improvement organization (QIO) patient status reviews under the two-midnight inpatient admissions policy. During the pause, CMS will work with the QIOs, Livanta and Kepro, to improve standardization of the QIO review process and will re-review claims previously denied by the QIOs. CMS advises hospitals to work with their QIOs to determine whether denied claims have been re-reviewed prior to appealing a claim denial. CMS anticipates that QIO reviews will resume within 60-90 days. CMS also released a Policy Decision Guideline flowchart that will be used to guide QIO determinations under the two-midnight policy.