CHA News Article

CMS Releases Updated Guidance on Two-Midnight Policy
MACs instructed to review claim denials to ensure decisions are consistent with updated guidance

On Feb. 24, the Centers for Medicare & Medicaid Services (CMS) posted a number of updated documents providing additional guidance regarding its two-midnight policy and related Probe & Educate audits. The updates, attached, include frequently asked questions about patient status review and guidance related to the review and selection of hospital claims for patient status reviews. CMS also announced it will require Medicare Administrative Contractors (MACs) to re-review all claim denials they have made under the Probe & Educate process to ensure the decision and subsequent education are consistent with the most recent CMS clarifications, issued Jan. 30. CMS urges providers to work with their MACs to determine if a claim has undergone final adjustment prior to submitting an appeal request.

In addition, CMS released preliminary data related to the Probe & Educate audit process, including examples of common claim denials during the process. CHA continues to provide guidance related to the two-midnight policy at CMS hosted a National Provider call today, and the slides have been posted on CHA’s website. A transcript will be posted when available.