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Washington Highlights

CMS Issues New Guidance on 2-Midnight Rule

November 8, 2013—The Centers for Medicare and Medicaid Services (CMS) Nov. 1 issued three new documents about the “2-Midnight Rule.” The new documents include additional guidance,  updated FAQs, and information for Medicare Administrative Contractors (MACs) about selecting hospital claims review.

The FAQs extend through March 31, 2014, the period during which Recovery Audit Contractors (RACs) will not be auditing claims of 0-1 midnight. MAC audits, known as “patient status probe reviews,” will continue during that time. The additional documents make no substantive changes in the final rule, which was part of the 2014 Inpatient Prospective Payment System (IPPS) rule. CMS remains skeptical that stays of 0-1 midnight (for which there never was an expectation of a 2-midnight stay) occur often, and characterizes such stays as being a reasonable inpatient admission “only in rare and unusual circumstances.”

In previous letters to CMS [see Washington Highlights, Sept. 20], the AAMC has argued a delay is necessary to provide an opportunity to adequately address the many issues that remain in this rule and the associated sub-regulatory documents. Such a delay should be more comprehensive and allow for stays of 0-1 midnight to be billed under Medicare Part A.

The association will continue to educate CMS about 0-1 midnight stays that should be routinely paid under Medicare Part A, and is also supportive of legislative efforts to require CMS to more fully delay the 2-Midnight Rule until reasonable clinical guidelines for inpatient stays of less than two midnights are established.

CMS also announced that it will hold a “Special Open Door Forum: Discussion of the Hospital Inpatient Admission Order and Certification: 2-Midnight Benchmark for Inpatient Hospital Admissions” on Nov. 12.


Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806