CMS Delays Two-Midnight Rule Again
By Christine Kern, contributing writer
CMS announces six-month delay in implementing Two-Midnight Rule, now slated to happen October 1
According to CapitalPro, Kenneth Raske, president of the Greater New York Hospital Association, has confirmed CMS is postponing implementation of the two-midnight rule until October 2014. The new CMS policies assume hospital error and unnecessary expenditures in cases where inpatients do not remain in a hospital bed for two midnights.
This marks the third time CMS has delayed the policy, which requires a patient stay in the hospital for more than two midnights before CMS will reimburse a hospital at inpatient rates. Additionally, last month the American Hospital Association (AHA) announced it “has geared up to begin a legal and legislative battle to delay or halt the new” rule.
The “two-midnight" policy, included in Medicare's inpatient payment rule for 2014, directs the agency's auditors to assume that hospital admissions with proper documentation are reasonable and necessary in cases where the patient stays in the hospital for more than a day – defined legally as spanning two midnights in a hospital bed.
The change was intended clarify Medicare rules that are seen as too vague about when a moderately sick patient should be admitted for expensive inpatient care versus outpatient observation. Hospitals have faced aggressive auditing over short inpatient stays, even though they say the rules didn't set clear standards.
According to Modern Healthcare, Medicare's recovery auditors initially were set to begin enforcing the rule Oct. 1, 2013, but postponed implementation to March 31, 2014 after providers complained. Last week, the agency punted again and said recovery auditors — who employ sophisticated data-mining to locate questionable claims — will now have to wait until after October 1 to officially audit claims under the two-midnight rule.
The agency will still allow Medicare's administrative contractors, who process claims for payment, to audit short stays and deny payment if the patient record doesn't support medical necessity. However, these reviews are
Want to publish your opinion?
Contact us to become part of our Editorial Community.
designed to be instructional, and must be limited to a sample of between 10 and 25 claims per hospital.
Raske responded to news of the delay, saying, “This is welcome news. The concerns expressed by all of you and our staunch collective advocacy on this issue have clearly influenced this delay.”