CHA News Article

New CMS Guidance Addresses Potential Exception to Two-Midnight Rule
Occurrence Code 72 adopted by NUBC

The Centers for Medicare & Medicaid Services (CMS) has released the attached guidance regarding the new inpatient admissions and medical review criteria identifying a potential exception to the two-midnight rule. Responding to stakeholder suggestions, CMS states that, in the rare case a physician expects patients with newly initiated mechanical ventilation will only require one “midnight” of hospital care, inpatient admission and Part A payment are appropriate. CMS notes the exception is not intended to apply to anticipated intubations related to minor surgical procedures or other treatment. CHA continues to seek input from the membership to share with CMS any additional categories of patients that should be added to the exceptions list. CMS urges suggestions to be emailed to IPPSAdmissions@cms.hhs.gov with “Suggested Exceptions to the 2 Midnight Benchmark” as the subject line.

Last week the National Uniform Billing Committee redefined a code in its billing data set to allow hospitals to denote inpatient claims meeting the CMS two-midnight benchmark through a combination of outpatient and inpatient services. Effective Dec. 1, hospitals can use Occurrence Code 72 on inpatient bills to denote the date span of contiguous outpatient hospital services that preceded the inpatient admission.

CMS has notified the Medicare Administrative Contractors to begin the probe audits of stays less than two midnights beginning Oct. 1. Noridian has posted information regarding the specific information that should be submitted during this probe audit period on its website

Finally, CMS has announced that, in addition to a Dec. 19 open door forum, it will host telephone training in mid-January using case scenarios to describe the application of the rule to real-life situations, as well as address frequently asked questions and answer questions from the public. CHA will inform members through CHA News when the call is scheduled. For additional resources, visit www.calhospital.org/resource/inpatient-admission-and-medical-review-resources.

 

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