Update to Medical Review Instructions for Inpatient Hospital Claims in Chapter 6 of Publication (Pub.) 100-08, Program Integrity Manual (PIM)
The purpose of this Change Request (CR) is to update sections 6.5.1 and 6.5.2, and, also, add Exhibit 48 in Chapter 6 of Pub. 100-08 PIM. These updates will remove the requirement in section 6.5.1 requiring contractors to utilize proprietary screening tools during review of hospital claims and provide minor language updates to section 6.5.2.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 12, 2025
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