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CMS Issues More 2-Midnight Guidance

February 28, 2014—Continuing the effort to clarify what is known as the “2-Midnight Rule” (i.e., that in general hospitals stays of less than two midnights should be billed to Medicare as outpatient services), the Centers for Medicare and Medicaid Services (CMS) Feb. 24 issued more guidance and on Feb. 28 held an open door forum to explain the new material and answer additional questions

Of most significance is that the CMS guidance addresses transfer cases.  The 2-Midnight Rule hinges on a physician’s expectation that a patient will be admitted for two midnights or more.  In the case of a transfer, the time spent at the initial hospital receiving care prior to transfer can be taken into account. However, according to CMS “any excessive wait times or time spent in the hospital for non-medically necessary services” is excluded from the physician’s admission decision.

CMS also requested that the Medicare Administrative Contractors (MACs) re-review all claim denials under the Probe & Educate process to ensure the claim decision and subsequent education is consistent with the most recent clarifications.


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