Livanta BFCC-QIO Short Stay Reviews
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Short Stay Reviews

Updates:

2/1/18 - Effective immediately, Providers can send questions directly to CMS about Short Stay Reviews related to the “Two-Midnight” rule. The mailbox address for these questions is SHORTSTAYREVIEW@cms.hhs.gov.

9/12/16 – 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 - 602 - 1510, Monday through Friday 9AM to 5PM.
The announcement is currently live on the QIO Program site.

8/24/16 – BFCC-QIOs are notified of the anticipation that short-stay reviews will resume soon, after further details from CMS.

6/8/16 - CMS released a new review graphic algorithm to the BFCC-QIOs to promote harmonization across all Medicare regions.

5/4/16 – 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

10/1/15 – 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.

Background:

How are reviews of short inpatient hospital stays conducted?

Livanta conducts “Short Stay Reviews” per 42 CFR 405.980 on a sample of Medicare Part A claims for appropriateness of inpatient admission under the Two Midnight Rule for acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities impacted by FY 2016 OPPS Final Rule, CMS-1633-F, effective January 1, 2016. CMS provides Livanta with a monthly universe of eligible paid provider claims with lengths of stay of less than two midnights. A provider is eligible for sampling once within a 6-month Round. As of April 2017, the top 175 providers with a high or increasing number of Short Stay claims per Area may be sampled for 25 cases, and other providers previously identified as having a “Major Concern” in the prior 6-month Round may be sampled for 10 cases.

Livanta conducts these reviews following CMS guidelines, which can be found at the following links:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/Reviewing-Short-Stay-Hospital-Claims-for-Patient-Status.pdf

https://qioprogram.org/sites/default/files/Policy%20Decision%20Guideline%20-%20Temporary%20Suspension%20of%20Two-Midnight%20Reviews%20DRAFT%2005.20.2016_0.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c01.pdf

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.