Monthly Archives: September 2016

BFCC-QIOs to Resume Two-Midnight Reviews

CMS has announced that, effective September 12, 2016, BFCC-QIOs will resume initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Part A payment for short stay hospital claims.  Per the CMS announcement, the temporary suspension, which was instituted on May 4, 2016, is being lifted because:

• The BFCC-QIOs successfully completed re-training on the Two-Midnight policy;
• The BFCC-QIOs have completed a re-review of claims that were previously formally denied;
• CMS examined and validated the BFCC-QIOs peer review activities related to short stay reviews;
• The BFCC-QIOs performed provider outreach on claims impacted by the temporary suspension; and
• The BFCC-QIOs initiated provider outreach and education regarding the Two-Midnight policy.

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Sarah Mendiola Presenting at the Maryland AAHAM Annual Institute

We are happy to announce Sarah Mendiola, F&W Director of Clinical Services and Senior Associate, will be presenting at the Maryland AAHAM Annual Institute in Ocean City, Wednesday September 14th.  Ms. Mendiola’s interactive presentation, “Don’t Let Denials Blast You from the Past: Front End Denials Prevention and Intervention,” will utilize actual case studies to explore different methodologies to combat denials due to lack of authorization, patient ineligibility, pre-existing condition exclusions, untimely submission of claims, under payments and inappropriate payer discounts.  Upon completion of the presentation, participants will be able to evaluate whether their facility is utilizing all opportunities for revenue enhancement through best denial management.  We hope to see you there!