News & Analysis

March 2, 2016
Medicare Insider

This week’s note is about changes in the April quarterly OPPS update. 

March 1, 2016
HIM Briefings

When the Quality Improvement Organizations (QIO) took over the role of education and enforcement for the 2-midnight rule on October 1, 2015, many anticipated that their reviews would only look at records from that date forward. But in an unpleasant turn of events, some hospitals have reported QIO record requests zeroing in on cases as far back as May 2015, says Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group for AccretivePAS in Chicago.

"It caught everybody off guard. No one expected them to audit any earlier than October 1," he says. "But audits are starting hot and heavy, and it's important for organizations to understand that it's permitted and that the QIOs can request charts going back six months."

According to a fact sheet, CMS is specifically using "Beneficiary and Family Centered Care (BFCC) QIOs, rather than MACs or Recovery Auditors, to conduct the initial medical reviews of providers who submit claims for short-stay inpatient admissions on October 1, 2015. Beginning in 2016, BFCC-QIOs will begin reviewing inpatient cases under the revised Two Midnight Rule being announced today." (For more information, visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-4.html.)

Another surprise? BFCC-QIOs are requesting charts for inpatient-only surgeries, something they weren't supposed to do, says Hirsch.

March 1, 2016
Briefings on HIPAA

Product Watch

March 1, 2016
Case Management Monthly

The American Hospital Association asked CMS to clarify some aspects of its new outpatient notification requirement, Notice of Observation Treatment and Implication for Care Eligibility Act, which is supposed to go into effect in the summer of 2016.

March 1, 2016
Case Management Monthly

At the completion of this educational activity, the learner will be able to:

March 1, 2016
HIM Briefings

In celebration of our 30th year of delivering you the latest in HIM, we continue to reflect on what HIM was like 30 years ago, examine today's HIM landscape, and look to the future.

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