Updates
Updated 5/22/2025
Today, the Centers for Medicare and Medicaid Services is notifying the public that Medicare Administrative Contractors (MACs) will perform short stay inpatient hospital medical reviews and provider education (i.e. patient status reviews). Those changes are detailed below:
Medicare Administrative Contractors: Beginning September 1, 2025, Inpatient Hospital short stay patient status reviews for acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities will transition from the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) (BFCC-QIO) to the MACs. MACs will perform reviews on a sample of Medicare pre-payment Part A claims as part of our current Targeted Probe and Educate (TPE) program. For more details on this program see: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/targeted-probe-and-educate-tpe.
Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) (BFCC-QIO) are currently conducting reviews, through August of 2025.
Frequently Asked Questions
Q. What is the Centers for Medicare and Medicaid Services (CMS) announcing?
A. On 5/22/25, CMS notified the public that Medicare Administrative Contractors (MACs) will perform short stay inpatient hospital medical reviews and provider education (i.e. patient status reviews). This type of review was previously conducted by the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) (BFCC-QIO). The BFCC-QIO is currently conducting reviews; with an anticipated ending of medical review activities in August 2025.
Q. When will MACs assume responsibility for these types of reviews?
A. The MACs will assume responsibility for conducting initial patient status reviews no earlier than September 1, 2025.
Q. What is the purpose of this type of MAC medical review and provider education?
A. The purpose of this type of medical review activity is to determine the appropriateness of Part A payment for short stay inpatient hospital claims and when warranted offer provider education.
Q. Will transition of this work from the BFCC-QIO to the MACs have a significant impact on Inpatient Hospital providers and beneficiaries?
A. MACs will conduct patient status reviews in accordance with established CMS policy. CMS believes this change will have minimal impact on providers and beneficiaries since there has been no change in policy.
Q. What process will the MAC use to conduct these reviews?
A. MACs will utilize the Targeted Probe and Educate (TPE) program to conduct Short Stay patient status reviews. This program allows providers to benefit from one-on-one education, and when applicable, intra-probe education and intervention to correct easily curable errors. For more information on the TPE program, please see: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/targeted-probe-and-educate-tpe.
Q. Does CMS plan to provide additional educational materials and provider education? When will CMS post additional information regarding transition of this work to the MACs?
A. Yes, CMS and the MACs will provide additional detailed information regarding the transition of patient status reviews at a later date.