Clinical criteria, documentation elements, and regulatory framework supporting inpatient admission. Three use modes for admission decisions, concurrent defense, and denial response.
151 conditions indexed3 use modesCMS 2-Midnight Rule alignedNot a replacement for payer criteria
151
Conditions indexed
30
Full criteria (Phase 1)
10
Body systems
5
Admission scenarios
Select use mode — the same criteria are surfaced differently for each scenario
Conditions
151 shown
Select a condition
Choose any condition from the left to see the clinical criteria, documentation elements, regulatory basis, and mode-specific guidance.
How to use the Inpatient Admission Framework
The ReveIQ Inpatient Admission Framework is built on the CMS 2-Midnight Rule (42 CFR § 412.3) and publicly available clinical guidance, authored from practitioner expertise. It is not a reproduction of InterQual, MCG, or any proprietary payer criteria product, and it is not intended to replace them in your hospital's utilization review workflow. Rather, it is a framework that helps your team build the clinical and regulatory case for inpatient admission when challenged.
Three use modes: • Admission Decision — for physicians and UR nurses evaluating status at the point of admission
• Concurrent Defense — for CDI and UR teams reviewing active inpatient cases and building the documentation chain
• Denial Defense — for appeal writers and UR teams responding to payer downgrade requests (surfaces counter-arguments specific to each condition)
Phase 1 launch includes 30 of the highest-volume inpatient admission conditions with complete content. The remaining 121 conditions are indexed and navigable, with full content coming in Phase 2. The tool structure itself is complete — filter, search, and cross-reference work across all 151 conditions.
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Important disclaimer. The ReveIQ Inpatient Admission Framework is authored from practitioner expertise and publicly available regulatory and clinical guidance. It is not a reproduction of InterQual, MCG, or any payer's proprietary criteria. It does not guarantee coverage, payment, or medical necessity determination. Always verify against current CMS regulations, your facility policies, and the specific payer contract terms applicable to each case. ReveIQ is a reference tool, not professional advice.