From a report suggesting that some payers have "hit the snooze button" on the new guidance, to a Humana leader expressing confidence that the company is applying the rule correctly, here are five updates on the two-midnight rule that Becker's has reported since Oct. 23:
1. George Renaudin, president of Humana's insurance segment, said the company is "very confident" it is applying the two-midnight rule correctly. A CMS audit verified that the company is following the regulation, executives said.
"Our clinicians continue to speak with many of the provider clinicians to talk through the issues, to make sure we all have a similar way of approaching this, that everyone is clear and has an understanding of what the two-midnight rule is and is not," Mr. Renaudin said.
2. Tenet CEO Saum Sutaria, MD, said the process of fully adopting the two-midnight rule guidance in the Medicare Advantage market is still underway and the Dallas-based system hasn't seen full adoption yet. Dr. Sutaria said the rule has "contributed somewhere between 50 and 100 basis points to our overall admissions growth."
This was less than Tenet expected, suggesting that payers have not fully adopted the two-midnight rule, and ties back to ongoing issues of disputes and denials — particularly in the Medicare Advantage market.
3. Nashville, Tenn.-based HCA Healthcare reported a modest reduction in prior authorization denials for accounts with two midnights or more, but still has "way too many denials," with large Medicare Advantage payers driving a significant portion of these denials, CEO Sam Hazen said.
4. Kevin Hammons, CFO of Franklin, Tenn.-based Community Health Systems, said payer tactics are becoming more aggressive and the system experienced an approximate doubling of denials in the third quarter compared to the same period last year. Denials have largely focused on claims affected by the two-midnight rule, but Mr. Hammons said that is only part of the issue.
"Maybe the two-midnight rule is the impetus, but we're seeing payers be more aggressive across many areas of denials," he said. "They're expanding the population of claims they deny, and while most of this activity is in Medicare Advantage, we're also seeing more denials in the commercial book as well."
5. Kodiak Solutions said its analysis of hospital inpatient and outpatient claims data suggests that payers are "continuing to apply their own criteria for inpatient admission and dismissing the two-midnight rule for Medicare beneficiaries."