The Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network (MLN) Matters article (SE1037) to provide guidance on admission decisions for inpatient acute care hospitals.The agency issued the MLN Matters article in response to inquiries from hospitals regarding the type of screening criteria that CMS contractors use for their medical necessity reviews. Under CMS rules, contractors are not required to use a specific screening tool for their reviews and may use various screening methodologies. The MLN Matters article, therefore, recommends that hospitals consult several resources when making admission decisions, including CMS’ national inpatient hospital policy and all National and Local Coverage Determinations. Additionally, hospitals should ensure that medical necessity determinations meet the criteria outlined in the CMS Program Integrity Manual and Medicare Benefit Policy Manual.
The Centers for Medicare & Medicaid Services. “Guidance on Hospital Inpatient Admissions Decisions.” MLN Matters Number: SE1037. 25 Jan. 2011.