Hospital Leaders to Congress: Two-Midnight Rule is Arbitrary, Confusing

Hospital leaders voiced deep concerns about CMS' two-midnight rule to congressional staffers yesterday at a briefing sponsored by the American Hospital Association, according to an AHA News report.

David Bronson, MD, president of Cleveland Clinic Regional Hospitals, said the rule is "arbitrary, difficult to implement and confusing to all of our staff," according to the report. Dr. Bronson spoke on a panel with leaders from Johns Hopkins Medicine in Baltimore and Mayo Clinic in Rochester, Minn.

The two-midnight rule is a new regulation that was included in the 2014 Medicare inpatient prospective payment system final rule. The rule generally considers inpatient admissions spanning two midnights as qualifying for payment under Medicare Part A. According to the regulation, stays lasting less than two midnights must be treated and billed as outpatient services. To assess compliance, Medicare administrative contractors will carry out prepayment patient status reviews for claims that span less than two midnights and have dates of admission on or after Oct. 1, 2013, and before March 31, 2014. Medicare contractors won't conduct post-payment patient status reviews for claims during that same period.

Hospitals have criticized the two-midnight rule since its release. The AHA has said the policy is unclear and undermines the medical judgment of physicians.

At the briefing yesterday, hospital leaders also advocated for the passage of the Two Midnight Rule Delay Act, which would extend CMS' enforcement moratorium through Sept. 30, 2014, to allow the agency time to develop a new payment methodology for short inpatient stays, according to the report.

Earlier this month, Wake Forest Baptist Medical Center in Winston-Salem, N.C., The Mount Sinai Hospital in New York City, and hospitals within Phoenix-based Banner Health and Philadelphia-based Einstein Healthcare Network took steps to challenge the rule and related policies by filing appeals. They asked the Provider Reimbursement Review Board to expedite judicial review of the hospitals' claims the two-midnight rule's 0.2 percent pay cut for hospitals in fiscal year 2014 is unlawful.

More Articles on the Two-Midnight Rule:
Hospitals Move Forward With Two-Midnight Rule Challenge
House Introduces Bill to Delay Two-Midnight Rule
The Two-Midnight Rule: What Hospitals and Health Systems Need to Know About Compliance 

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