Hospital short stay patient status reviews

The Centers for Medicare & Medicaid Services (CMS) is announcing today that Medicare Administrative Contractors (MACs) will perform short stay inpatient hospital medical reviews & provider education (i.e., patient status reviews).

Beginning on September 1, 2025, the MACs will assume responsibility for conducting patient status reviews of facilities to determine the appropriateness of Part A payment for short stay inpatient hospital claims, which were previously conducted by the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) (BFCC-QIO). While this change impacts where medical record requests will be sent and the contractor making claim review decisions, the policy for assessing short stay inpatient admissions remains unchanged.

Additional information is available on the CMS Medical Review and Education Webpage: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/hospital-patient-status-reviews

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