The Centers for Medicare & Medicaid Services (CMS) posted two summaries of the technical direction CMS plans to issue to Medicare administrative contractors (MACs) related to review criteria for the two midnights policy. The two midnights policy is part of the fiscal year 2014 Inpatient Prospective Payment System final rule. The rule established a time-based presumption of medical necessity for physician-ordered hospital inpatient admissions for Medicare beneficiaries that span at least two midnights. In the summaries, which cover selecting hospital claims for patient status reviews and reviewing hospital claims for patient status, CMS offers direction to MACs on how to select hospital claims they will review during a probe and educate program for inpatient admissions that took place between Oct. 1, 2013 and March 31, 2014. The probe and educate program allows MACs to review a sample of inpatient claims at a hospital and conduct educational outreach efforts with the hospital if necessary.
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