CMS Postpones “Two Midnight” Rule
- By BSTQ Staff
The Centers for Medicare & Medicaid Services (CMS) has delayed the new “two midnight” rule for Medicare hospital admissions until after Sept. 30. As part of Medicare’s inpatient payment rule for 2014, the rule directs the agency’s auditors to assume that a patient’s hospital admission was reasonable and necessary if they were admitted to the hospital with proper documentation for more than a day — defined legally as spanning two midnights in a hospital bed.
The change was intended to address widespread complaints that Medicare’s rules are too vague about when a moderately sick patient should be admitted for expensive inpatient care instead of outpatient observation. Hospitals have faced aggressive auditing over short inpatient stays, even though they say the rules didn’t set clear standards. But, hospitals aren’t happy with the new rules, either, because they are presumed to have made an error and provided medically unneeded care if an inpatient doesn’t spend two midnights in a hospital bed.
This is the second delay in enforcing the two midnight rule, which was originally scheduled to go into effect on Oct. 1, 2013. CMS will continue to allow Medicare’s administrative contractors to review short stays and deny payment if the patient record does not support medical necessity. However, those reviews are anticipated to be informative and will be limited to a sample of between 10 and 25 claims per hospital.
