Another Delay for the Two-Midnight Rule

18 August 2015 Health Care Law Today Blog

The Centers for Medicare and Medicaid Services (CMS) announced, on August 12, 2015, that it has extended the enforcement delay of the controversial two-midnight rule governing short hospital stays until the end of the year. As set forth in the FY 2014 IPPS Rule, the two-midnight rule imposes financial penalties for services that recovery auditors deem should have been documented as outpatient services. The enforcement delay had been set to expire on September 30, 2015.

Pursuant to the extension, CMS says that it will not allow Recovery Audit Contractors to conduct patient status reviews of short-term hospital admissions through the end of 2015.

Under the current rule, an inpatient admission under Medicare Part A is considered appropriate when the physician expects a case will require a two-midnight stay. Cases that fall short of this rule and do not meet medical necessity requirements for admission may be converted to and paid as an outpatient visit.

The postponement coincides with the proposed changes to the short-stay rule that the agency issued in July in which CMS proposed that the rule be modified to allow physicians to exercise judgment to admit patients for short stays on a case-by-case basis.

In addition to the enforcement delay, CMS also clarified other previously-announced policy changes:

  • As of October, Quality Improvement Organizations (QIOs) will be responsible for initial patient status reviews to assess the need for Part A payments for short-stay inpatient claims.
  • From October through the end of 2015, QIOs’ patient status reviews will be based on the current two-midnight policy.
  • The third round of Probe and Educate reviews will likely conclude by September 30, 2015.
This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney. This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites. In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.

Related Services

Insights

Bad Holiday Season News! Estimates of an increase of Cyberattacks 20%!
13 December 2019
Internet, IT & e-Discovery Blog
Driving the Future of Automotive Technology
12 December 2019
Manufacturing Industry Advisor
Massachusetts Governor Proposes Facility Fee Ban
12 December 2019
Health Care Law Today
American Rule Prevails; PTO May Not Collect In-House Attorneys' Fees as "Expenses"
12 December 2019
IP Litigation Current
ACCC 46th Annual Meeting & Cancer Center Business Summit
04-05 March 2020
Washington, D.C.
Foley/Deloitte Compliance and Privacy Officer Roundtable
27 February 2020
Boston, MA
Let’s Talk Compliance
24 January 2020
Orlando, FL
New England Alliance Annual Meeting
15-17 January 2020
Woodstock, VT