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AHA faults CMS' guidance on admission, medical review criteria policy

July 26, 2013

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The AHA expressed disappointment with the Centers for Medicare & Medicaid Services’ (CMS) Sept. 26 guidance on the admission and review criteria it adopted in the fiscal year 2014 hospital inpatient prospective payment system final rule. The agency reiterated that Medicare Administrative Contractors and Recovery Audit Contractors are not to review claims spanning more than two midnights after admission for a determination of whether the inpatient hospital admission was appropriate. CMS also announced that, for a period of 90 days, it will not permit RACs to review inpatient admissions of one midnight or less that begin Oct. 1. CMS “failed to provide the hospital field with much needed information on the two-midnight policy,” said AHA President and CEO Rich Umbdenstock. “Unfortunately, the agency’s guidance only raises new questions and lacks clarity.” He urged CMS to “suspend this rule and immediately start dialog on a new policy direction that includes consideration of a payment option.”

For more, click on: http://tinyurl.com/prfejd7.