CHA News Article

CMS Issues Additional Information on Two-Midnight Rule
CMS grants 90-day implementation period

The Centers for Medicare & Medicaid Services (CMS) today released additional information regarding the “two-midnight” benchmark and presumption for inpatient admission and medical review criteria. During its hospital open door forum, CMS announced that it will not allow post-payment review of patient status by the MACs or the RACs on inpatient claims that span two midnights for admissions beginning on or after Oct. 1 through Dec. 31, 2013. Further, it will not permit RACs to review inpatient admissions of one midnight or less that begin on or after Oct. 1, 2013. When asked if CMS would prohibit review of these claims at a later date, CMS staff confirmed that it is not their intention to have these claims reviewed at a later date.  

CMS has instructed the MACs to do probe reviews of between 10-25 claims per hospital on inpatient hospital claims spanning less than two midnights after admission with the dates of admission on or after Oct. 1, 2013 through Dec. 31, 2013.  The probe audits will be conducted on a prepayment basis and will inform future CMS education and guidance. The full guidance document is attached and has been included on CHA’s list of inpatient admission and medical review resources at www.calhospital.org/resource/inpatient-admission-and-medical-review-resources. CMS notes that it will continue to update the CMS website at www.cms.gov/medical-review with additional FAQs as they become available.

 

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