QIO: Documentation of Two-Midnight Expectation Is Sinking Claims

Some variation on the theme of failing to document the two-midnight expectation explains most of the denials for short-stay admissions, according to the results of the second year of reviews by Livanta, the CMS contractor that reviews hospital compliance with the two-midnight rule.[1]

Livanta, a Beneficiary and Family Centered Care-Quality Improvement Organization (QIO), reviewed 21,510 short-stay claims from hospitals across the country between Nov. 1, 2022, and Oct. 31, 2023. Ninety percent were approved and 10% denied.

Here are the top reasons for the denial:

  • “Provider documentation in support of a two-midnight expectation at the time of the admission order is insufficient.”

  • “The plan of care does not support a reasonable expectation of two midnights of hospital care.”

  • “The need for inpatient care without a two-midnight expectation is not supported by provider documentation regarding the patient’s documented medical needs and risk for an adverse event.”

  • “Misclassification of a procedure as being on the Inpatient-Only List for the date the procedure is performed.”

This document is only available to subscribers. Please log in or purchase access.

Would you like to read this entire article?

If you already subscribe to this publication, just log in. If not, let us send you an email with a link that will allow you to read the entire article for free. Just complete the following form.

* required field