title: CMS proposes to OK one-midnight inpatient stays.
abstract: The Centers for Medicare & Medicaid Services (CMS) has proposed that stays shorter than two midnights be reimbursed as inpatient stays if the documentation in the medical record supports it. CMS made the proposal in the Outpatient Prospective Payment System proposed rule for 2016 and left the policy unchanged for stays of two midnights or longer. CMS also announced that the two Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs), Livanta and KEPRO, will take over the responsibility of Probe and Educate and will review cases for medical necessity when patient stays are one midnight or less, referring hospitals with high denial rates to the Recovery Auditors. Case managers should continue to assist physicians in determining patient status and to make sure that the documentation is complete, accurate, and specifies the severity of illness.
mesh_terms: D019090:Case Management; D014487:Centers for Medicare and Medicaid Services, U.S.; D004636:Emergency Service, Hospital / Q000191:economics*; D033161:Government Regulation; D007902:Length of Stay / Q000331:legislation & jurisprudence; D012051:Reimbursement Mechanisms; D014481:United States