Changes proposed to the 2-midnight rule

Physician judgment and Medicare Quality Improvement Organizations should play bigger role in 2-midnight rule, CMS has proposed.

Last week, CMS announced proposed revisions to the 2-midnight rule for determining when inpatient admissions are appropriate for payment under Medicare Part A.

The rule has been revised for stays expected to last less than 2 midnights, the agency said. Under the proposed new rule, stays expected to be shorter than 2 midnights would be “payable under Medicare Part A on a case-by-case basis based on the judgment of the admitting physician” with appropriate supporting documentation and excluding procedures not on the inpatient-only list or otherwise listed as a national exception. The agency reiterated, however, that “it would be rare and unusual for a beneficiary to require inpatient hospital admission for a minor surgical procedure or other treatment in the hospital that is expected to keep him or her in the hospital for a period of time that is only for a few hours and does not span at least overnight.” There will be no policy changes for stays over the 2-midnight benchmark.

The other significant proposed change is that Quality Improvement Organizations (QIOs) will conduct first-line medical reviews of claims for inpatient admissions, with the Recovery Audit program focusing on only those hospitals with consistently high denial rates. QIO patient status reviews will focus on educating doctors and hospitals about the Part A payment policy for inpatient admissions, the agency said.

Comments on the proposed changes to the 2-midnight rule will be accepted until Aug. 31, 2015, and a final rule will be issued on or around Nov. 1, 2015, according to the CMS fact sheet.