Posts Tagged 'Two Midnight Rule'

“Two Midnight” rule is here to stay – partially

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Last week, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes to the highly controversial “Two Midnight” rule that governs inpatient vs observation stays at hospitals and has resulted in many patients not qualifying for skilled nursing care. As part of the 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Payment Rule, the section on the “Two Midnight” rule states that CMS proposes to modify the existing “rare and unusual” exceptions policy ...

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MedPAC recommends “Two Midnight Rule” be withdrawn

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In its June 2015 Report to Congress, MedPAC reviewed hospital short-stay policy issues and provided several recommendations to reduce these issues. Hospital short stays have caused significant issues for beneficiaries who need to qualify for post-acute care at a skilled nursing facility and were widely reported on in 2015.

In response to this problem, this past March the NOTICE Act passed the House, which requires hospitals to provide notification to patients that they were under observation status and had not ...

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NOTICE Act to inform about observation status passes House

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On March 16, 2015, The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act passed the House of Representatives. H.R. 897, if it becomes legislation, would require hospitals to provide both written and oral notification to patients who are under observation status. Specifically, it would require that any patient in observation status at a hospital for more than 24 hours be notified within 36 hours of receiving services that they are not considered to be inpatient status. The ...

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“Two Midnight” Rule on its Way to Court

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The American Hospital Association (AHA) issued a press release that it has filed two lawsuits challenging the controversial “two midnight” stay requirement on inpatient admissions at hospitals. CMS has issued a guidance letter in early March to provide clarification to providers about information that may have affected their rejected claims. The President & CEO of AHA, Rich Umbenstock, noted in the press release that “hospitals stand by a physician’s decision on what care is appropriate for each patient” ...

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CMS Clarifies Two Midnight Rule (Again) with New Guidance Letter (2/24)

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On February 24th, the Centers for Medicare & Medicaid Services (CMS) issued a guidance letter regarding its controversial Two Midnight Rule that has been extremely confusing to providers. Not even a month prior to this announcement, CMS announced that it was extending the “probe and educate” period for Medicare Administrative Contractors (MACs) through September 14th, 2014. The review period had originally been slated to end on March 31, 2014. The new guidance from CMS, “Medicare Inpatient Hospital Probe ...

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CMS Open Door Forum Clarifies Hospital “Two Midnight Rule” for Inpatient Stays

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During a special Open Door Forum held Thursday, September 26, 2013, “Final Rule CMS-1599-F: Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions,” CMS staff members tried to provide further clarity on its newly announced Two Midnight Rule for Medicare beneficiary inpatient stays.

The agency began the discussion by listing out its reasons for issuing rule CMS-1599 regarding inpatient admissions, including:

  1. The growing concern among beneficiaries that the number of observation stays is on the ...
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Observation Stay Lawsuit Dismissed in Court, Leaving Many with Out of Pocket Costs

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The Medicare observation stay “loophole” has been frustrating to both hospitals and Medicare beneficiaries for the past several years. The three day in-patient stay requirement has been confusing and unclear to patients, and hospitals have RAC auditors breathing down their necks as they take a hard look at short-term hospital stays. Thus, many who require skilled nursing services after a visit to the hospital are left high and dry to pay for these necessary – but expensive – services on ...

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CMS Clarifies Payments with “Two Midnight Rule” for Hospital Admissions

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Earlier in August, CMS published a final rule on hospital inpatient admissions (among other items), providing clarity on how payments will be provided for inpatient status.  It has been brought to light that may Medicare beneficiaries had been spending time under “observation stay” status as opposed to “inpatient” status, which prevented them from reaching the three-day threshold required to have skilled nursing services covered. These changes will be applicable to hospital discharges that occur on or after October 1, ...

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