NAPGCM Public Policy E-Newsletter: Delay of the Two-Midnight Rule February 12, 2014

Delay of the Two-Midnight Rule
Released to NAPGCM Membership on February 12, 2014

The Center for Medicare and Medicaid Services (CMS) announced last week that it won't enforce the new "two-midnight" rule for determining inpatient hospital stays until October. The rule was scheduled to take effect in April.

The two-midnight rule was meant to decrease the number of extended outpatient hospital stays, presuming patients are in-patients if they have passed two midnights under the care of a hospital. However, the hospital community has opposed the two-midnight rule as being unworkable.

The moratorium means that

  • Medicare Administrative Contractors (MACs) will continue to select claims for review with dates of admission between March 31, 2014 and September 30, 2014. MACs will continue to review and deny claims found not in compliance with CMS-1599-F (commonly known as the "Two-Midnight Rule").
  • MACs will continue to hold educational sessions with hospitals as described below in "Selecting Hospitals for Review" through September 30, 2014.
  • Generally, Recovery Auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through October 1, 2014.

For further information on the two-midnight rule moratorium and related policies click here.