CMS Updates Two-Midnight Rule Guidance for Canceled Surgical Procedures

CMS will instruct Medicare review contractors to use the general two-midnight benchmark instruction when reviewing claims that involve canceled surgical procedures, according to updated two-midnight rule guidance from the agency.

That means that if the physician expects a patient going in for surgery to require a hospital stay that spans two or more midnights at the time of admission and documents that expectation in the medical record, the inpatient admission will be considered appropriate for payment under Medicare Part A, according to CMS.

The two-midnight rule — which was included in the 2014 Medicare inpatient prospective payment rule — specifies 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. Enforcement of the two-midnight rule starts this October.

Hospital leaders, physicians and healthcare groups have fiercely opposed the rule, saying it is unclear and undermines the medical judgment of physicians. The American Hospital Association has expressed concerns about the rule and support for the newly proposed bill.

Earlier this month, Sens. Robert Menendez (D-N.J.) and Deb Fischer (D-Neb.) introduced the Two-Midnight Rule Coordination and Improvement Act, which would establish new guidelines for CMS' creation of criteria payment methodologies concerning short inpatient hospital stays. Rep. Menendez called the current two-midnight regulation "rigid" and said in a news release it could interfere with physicians' ability to make proper medical determinations.

More Articles on the Two-Midnight Rule:
Senate Two-Midnight Rule Bill Would Require New Payment Guidelines  
CMS Posts Guidance on Two-Midnight Policy, Audits  
7 Statistics on the Clinical Impact of the Two-Midnight Rule 

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