– CMS notified the BFCC-QIOs that they may resume review of short-stay claims. Livanta will begin the process of requesting medical records from providers within a week. Providers who had short-stay claims in process at the time of the pause can also expect to receive letters from Livanta indicating the status of these claims in the next few weeks. If you have questions regarding this program, please call Livanta’s Short Stay HelpLine at 1 866 - 603 - 0970
, Monday through Friday 9AM to 5PM.
The announcement is currently live on the QIO Program site.
– BFCC-QIOs are notified of the anticipation that short-stay reviews will resume soon, after further details from CMS.
- CMS released a new review graphic algorithm to the BFCC-QIOs to promote harmonization across all Medicare regions.
– CMS temporarily paused the BFCC-QIOs’ performance of initial status reviews to promote consistent application of the medical review of patient status for short hospital stays
– The BFCC-QIOs assumed responsibility for conducting initial patient status reviews of providers to determine the appropriateness of Part A payment for short-stay inpatient hospital claims.
How will reviews of short inpatient hospital stays be conducted?
The reviews will examine the appropriateness of inpatient admission under the Short Stay Reviews and will incorporate a medical necessity review based on the pertinent Medicare coverage policies. The types of facilities included in these samples will be acute-care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities. These reviews will not be performed on inpatient rehabilitation facilities or critical access hospitals.
CMS will provide the BFCC-QIO with a monthly sample of eligible paid provider claims with lengths of stay of less than 2 midnights. Excluded from this sample will be Medicare Advantage claims, claims for indirect medical education, and Medicare as secondary payer claims. The sample will also exclude claims where the discharge status code is beneficiary death, transfer to another inpatient hospital facility, or departure against medical advice, as well as those claims for procedures listed in the outpatient prospective payment system (OPPS) inpatient-only list. Those providers currently identified under Zone Program Integrity Contractor (ZPIC)/Benefit Integrity Support Center (BISC) as “do not pursue” will be excluded from the sample.
A hospital will only be sampled once in a 6 month period. Large hospital samples will consist of 25 claims and other hospital samples will be comprised of 10 claims. Review results will be summarized for each provider and provider education will be conducted via letter and/or telephonic conferences. Results will be shared with CMS, the MACs for any admission denials, and when appropriate, the RACs.
What role will the Recovery Audit Contractors (RACs) continue to have in the review of short inpatient hospital stays?
Livanta continues to work with CMS on what role the RAC will have in the Short Stay Reviews process. As soon as we have additional information we will share it here.
Short Stay Reviews FAQ
We have prepared an additional Short Stay Reviews Frequently Asked Questions with questions an answers directly from providers and also a presentation with lots of in-depth information.
Short Stay Reviews FAQ