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Building an internal electronic process for Medicare short-stay admission reviews

Anuja Mohla (amohla@christianacare.org) is Senior Physician Advisor and Medical Director Patient Access & Flow at ChristianaCare Health Care System in Newark, DE, and Patty Resnik (presnik@christianacare.org) is Vice President, Operations, at ChristianaCare Center for Virtual Health in Wilmington, DE.

The Centers for Medicare & Medicaid Services (CMS) implemented the two-midnight rule as part of the fiscal year 2014 Inpatient Prospective Payment System final rule. In December 2016, the Office of Inspector General (OIG) published a report identifying remaining vulnerabilities in healthcare systems since the two-midnight rule.[1] OIG expressed concerns regarding acute hospitals submitting costlier Part A inpatient claims instead of Part B outpatient claims for “short stays,” defined as hospital stays of less than two midnights. Thus, the OIG recommended CMS conduct a routine review of short-stay admissions and target hospitals with high numbers of these potentially inappropriate claims.

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