Quality of Care: Brace Yourself for New Scrutiny of Your 'Two-Midnight Rule' Compliance

Why This Topic Matters

Hospitals and billing teams need to understand how short-stay claims may be reviewed and what documentation practices can affect audit risk, denial exposure, and compliance workflows.

Article Sections

1. Beware: New QIO Limitations Don’t Extend to Other Contractors

   Explains the contractor landscape for short-stay claim review and how oversight responsibility is changing. It also places the discussion in the context of CMS, OIG, and related audit contractors.

2. Watch Out for 3 Red Flags

   Describes the general review pathway and the types of provider patterns that can prompt additional scrutiny. The section also notes related review activity under CMS policy updates for the 2016 cycle.

3. Best Strategy: Focus on Documentation

   Focuses on documentation quality and internal monitoring processes as key themes in reducing audit exposure. It highlights the importance of pre-billing review controls and compliance protocols.