CMS Article Highlights Guidance for Hospitals on Inpatient Admissions - February 1, 2011

In a recent MLN Matters article, the federal Centers for Medicare & Medicaid Services (CMS) responded to hospital concerns about how CMS’s Recovery Audit Contractors, Fiscal Intermediaries and the Comprehensive Error Rate Testing contractor are making medical necessity documentation on inpatient hospital claims. In particular, the article points hospitals to the Medicare Program Integrity Manual guidance on screening instruments and the first chapter of the Medicare Benefit Policy Manual. The article goes on to stress that staff involved in clinical decision-making must monitor CMS guidance and national and local coverage determinations. It also states that any medical documentation must demonstrate evidence of clinical need for the patient to be admitted and clearly describe care provided subsequent to the patient’s admission.