Dive Brief:
- CMS is requiring its auditors to double check all Medicare inpatient claims denied payment under the new "two-midnight" rule since October 1.
- The two-midnight rule has proven difficult to roll out for the nation's 5,000-odd Medicare-receiving hospitals, and additional clarifications issued in September and January seem to have made things worse.
- Since, CMS has admitted that Medicare contractors may have denied claims for reasons no longer supported under the latest updates of the "two-midnight" rules. CMS wants to a review all denials under the new rule so far, a process that will be handled outside the normal appeals process for payment denials.
Dive Insight:
You heard it folks: this is as close as you're going to get to CMS saying, "I'm sorry." The agency isn't saying how many claims have been denied under the existing two- midnight policy, but it is admitting that in at least some cases, the denials may have been unwarranted. By the way, CMS is waiving the normal 120-day window to appeal for denials under the two-midnight rule, but only for decisions that predate the January 30 rules. All told, going through a re-review may not be much more fun than the original review, but at least it's a shot at getting from your money back.