CMS to discuss 2-midnight rule review suspension

CMS is expected next week to discuss potential changes to 2-midnight rule audits by Quality Improvement Organizations (QIO) after quietly suspending the reviews in early May.

The agency has listed the topic on the agenda for its upcoming Hospital Open Door Forum call, which will take place Tuesday, June 7, at 2 p.m.

Kepro and Livanta, the QIOs responsible for performing the reviews, updated their websites to note that CMS had asked them on May 4 to temporarily suspend audits to “ensure claim decisions and subsequent educational initiatives are consistent with CMS policy.” A Kepro representative said the postponement is expected to be brief and official communication from CMS is expected next week.

Records that providers have previously submitted to QIOs will remain in the pipeline awaiting review until further direction from CMS, according to Livanta, and providers will have at least six weeks to implement changes prior to the next round of reviews.

This suspension comes on the heels of CMS proposing to reverse the 0.2% payment cut associated with the 2-midnight rule in the 2017 IPPS proposed rule after a protracted legal battle with hospital associations.

The IPPS rule did not include any tweaks to the 2-midnight rule, but it’s possible the agency is suspending reviews pending proposals in the 2017 OPPS rule, due in early July, which was the vehicle for last year’s handover of reviews from Recovery Auditors to QIOs.

The CMS call will also include information on new regulations for reporting discarded drugs with modifier -JW (drug amount discarded/not administered to any patient) and the IPPS wage index. Medicare Compliance Watch members can access recordings of Hospital Open Door Forum calls in the Resources section.