CMS Extends Enforcement Delay of ‘Two-Midnight’ Rule
On Wednesday, CMS announced that it would extend an enforcement delay on the "two-midnight" rule through the end of the year, Modern Healthcare reports. The delay originally was scheduled to expire Sept. 30 (Rubenfire, Modern Healthcare, 8/12).
Under the two-midnight rule, an admission is assumed to be appropriate for a Medicare Part A payment if a physician expects a patient's treatment to require a two-night hospital stay and admits him or her under that assumption (California Healthline, 3/18).
The rule has been in place since 2013 but has never taken effect.
Earlier this year, CMS proposed several changes to the rule that would take effect in November. Under the revisions, CMS would permit certain case-by-case exceptions to the rule. Certain short hospital stays could be covered under inpatient payment rules, depending on a physician's judgment. Physicians who admit patients for what they anticipate will be short stays would have to document factors supporting their decision.
In addition, CMS said it would remove the oversight administrative contractors have over physician admission decisions. CMS would call for quality improvement groups to enforce the policy. Under the revisions, recovery audit contractors would be told to focus efforts on hospitals that have a suspicious number of denied claims (CMS fact sheet, 7/1).
According to Modern Healthcare, administrative contractors currently are teaching hospitals about the rule and investigating current claims for errors related to the policy. The process will continue through September and possibly into October.
The quality improvement groups in October will start conducting reviews using current payment policies. They will enforce the rule as of Jan. 1.
The American Hospital Association had called for CMS to extend the delay. AHA in an email to members said the extension "will continue to prevent recovery audit contractors from issuing inappropriate denials for medically necessary patient care" (Modern Healthcare, 8/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.