CMS Softens the Two-Midnight Rule

July 2nd, 2015

The Centers for Medicare and Medicaid Services (CMS) is proposing to allow hospital stays that are less than two midnights to be reimbursed as inpatient stays on a case-by-case basis provided the documentation in the medical record supports the inpatient admission.

CMS made the proposal in the 2016 Outpatient Prospective Payment System (OPPS) proposed rule, saying the change was made based on feedback from hospitals and physicians and to emphasize the role of physician judgment.

The policy is unchanged for stays of two midnights or longer.

CMS also proposed using Quality Improvement Organizations (QIOs) to conduct patient status reviews would oversee the majority of patient status audits with the Recovery Auditors reviewing only hospitals with high denial rates based on the QIO patient status reviews.

Look for more coverage of the rule, including expert commentary, in the September issue of Hospital Case Management. AHC Media's upcoming July 16 webinar, Making the Two-Midnight Rule Work for You, will also provide more information on the new rules.