CMS Issues Additional Guidance on Two-Midnight Hospital Admissions Rule

CMS has issued more guidance related to its new regulation that generally considers inpatient admissions spanning two midnights as qualifying for payment under Medicare Part A.

In terms of enforcing the regulation, the agency's website states it won't conduct post-payment patient status reviews for claims with dates of admission from Oct. 1, 2013 through March 31, 2014 — three months longer than previously indicated.

CMS included the two-midnight rule in its final rule on 2014 Medicare inpatient prospective payment system rates. Under the policy, inpatient admissions are considered reasonable and necessary for Medicare beneficiaries who require more than a one-day stay or who need treatment specified as inpatient only. The rule determines that stays lasting less than two midnights should have been treated and billed as outpatient services.

Medicare administrative contractors will conduct prepayment patient status reviews for claims with dates of admission on or after Oct. 1 but before March 31, according to CMS. MACs will select a sample of 10 claims for most hospitals (25 for large hospitals) and conduct educational outreach efforts and repeat the process if necessary, based on the results.

More Articles on Medicare Hospital Payments:
CMS Issues Guidance On "Two Midnights" Hospital Payment Rule
House Lawmakers: Delay Medicare "Two Midnights" Rule for Hospital Stays
CMS Releases Final Rule on 2014 Inpatient Payments 

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