Q&A: BFCC-QIO Short-Stay Audits

September 23, 2016
Medicare Web

Q: What is the current status of the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) short-stay reviews?

A: Back in May, CMS put a hold on short-stay inpatient audits related to the 2-midnight rule. That hold was lifted effective September 12, 2016, according to a FAQ published by CMS.

According to the FAQ, CMS decided to lift this temporary suspension for five reasons, which are as follows:

  1. BFCC-QIOs were successfully retrained on 2-midnight rule
  2. BFCC-QIOs finished a re-review of claims that were formally denied
  3. CMS “examined and validated the BFCC-QIOs peer review activities related to short stay reviews”
  4. BFCC-QIOs reached out to providers on claims that were affected by the temporary suspension
  5. BFCC-QIOs started provider outreach and education on the 2-midnight rule

CMS said that BFCC-QIOs will continue to follow the guidance called, “Reviewing Short-Stay Hospital Claims for Patient Status.”

Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago, answered this question. More information will be available in the November issue of Case Management Monthly.

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