CMS Delays Two-Midnight Rule

CMS has delayed the two-midnight rule through Sept. 30 after fierce opposition came from hospitals, physicians and other healthcare groups.

NewCMSlogoThe two-midnight rule is a new regulation included in the 2014 Medicare inpatient prospective payment rule. The policy established that inpatient admissions spanning at least two midnights qualify for Medicare Part A payments. Inpatient stays lasting fewer than two midnights must be treated and billed as outpatient services.

According to a CMS update, the enforcement of the two-midnight rule will not begin until this October. This means Medicare administrative contractors and recovery auditors will not conduct two-midnight post-payment reviews of claims with admissions dates between Oct. 1, 2013, and Oct. 1, 2014. However, MACs and RAC will carry out prepayment reviews of hospital admissions that occur between March 31, 2014, and Sept. 30, 2014. Depending on the hospital, auditors will review 10 to 25 claims per facility.

Kenneth Raske, president of the Greater New York Hospital Association, sent a letter to members informing them of the update. He said it was "welcome news," but "the fact remains…that the two-midnight policy still stands, and GNYHA continues to support legislation to create an appropriate payment mechanism for short inpatient stays."

Hospital leaders have vigorously opposed the two-midnight rule during the past year. Hospitals have said the policy is unclear and undermines the medical judgment of physicians. CMS introduced the policy to better monitor Medicare payment of short inpatient stays and ensure inpatient admissions are medically necessary.

More Articles on the Two-Midnight Rule:
CMS to Hold Conference Call on Two-Midnight Rule
Hospital Leaders to Congress: Two-Midnight Rule is Arbitrary, Confusing
5 Big Mistakes Hospitals Make When Dealing With RAC Audits

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