How To Best Prepare for Two-Midnight Rule Changes

RCM Answers

MRO’s Lula Jensen, MBA, RHA, CCS, Director of Product Management, offers her insight in an RCM Answers article titled “How to Best Prepare for Two-Midnight Rule Changes.”

CMS recently announced some adjustments to the Two-Midnight Rule, including clarifications on exceptions. Here’s what you need to know.

On June 13, 2017, the Centers for Medicare and Medicaid Services (CMS) issued clarification regarding the medical review requirements for Part A payment of short-stay hospital claims, more commonly referred to as the “Two-Midnight Rule.” For providers submitting institutional claims to Medicare Administrative Contractors (MACs) for inpatient hospital services provided to Medicare beneficiaries, Medicare Part A payment is generally not appropriate for hospital stays expected to span less than two midnights.

Hospital stays generally are payable under Part A if the physician expects the patient to stay two midnights and rationale is fully documented in the patient’s medical record. Rationale must be supported by clinical documentation. Medicare reviewers will take a look at all medical record documentation in these cases.