CHA News Article

CMS Releases Additional Guidance on Two-Midnight Policy

The Centers for Medicare & Medicaid Services (CMS) has released additional guidance regarding the two-midnight inpatient hospital medical review and admission criteria. CMS indicates that it will not conduct post-payment patient status reviews for claims with dates of admission Oct. 1, 2013, through March 31, 2014, three months longer than previously announced. In addition, CMS posted the attached documents setting forth more details on the “probe and educate” audits that will be conducted by Medicare Administrative Contractors. However, the guidance leaves a number of questions unaddressed, and certain areas appear to be inconsistent with guidance previously issued by the agency. For example, the new guidance states that critical access hospitals (CAHs) will be included in the probe audits, although previous guidance specifically excluded CAHs from the audits. CHA will continue to seek clarity from both CMS and Noridian and will provide members with additional information as it becomes available. For additional resources on the policy, visit