CMS clarifies two-midnight rule after enforcement delay announcement

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The Centers for Medicare & Medicaid Services (CMS) clarified some details on the controversial "two-midnight rule," shortly after its decision to delay implementation of the rule until October--the third such hold-up, according to the Healthcare Financial Management Association. 

Under the rule, a patient must stay in a hospital for two consecutive midnights before Medicare reimburses the hospital at inpatient rates. In its clarification, made during a Tuesday conference call, CMS officials specified that hospitals must include the admitting physician's signature before discharge in their documentation of patients admitted under the rule, HFMA reports.

Even if another clinician who lacked admitting privileges entered the patient's information, the admitting physician's signature would be sufficient certification, according to Daniel Schroeder, a member of CMS' division of acute care, HFMA reported.

Hospitals must also include documentation if they discharge an inpatient before the two-midnight threshold due to unforeseen circumstances, Schroeder said in the call. Furthermore, if the admitting physician's doesn't sign, Schroeder said, hospitals must treat the care as Part B outpatient care, which carries lower payments, when seeking reimbursements.

CMS announced the implementation delay over the weekend; the rule would have gone into effect March 31. Although hospital groups applauded the move, Greater New York Hospital Association President Kenneth Raske told Capital New York his group would "continue to vigorously oppose the two-midnight policy and seek to overturn it through both legislation and the judicial process," FierceHealthFinance previously reported.

To learn more:
- here's the article
- read the clarification sheet

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