The Centers for Medicare & Medicaid Services (CMS) once again delayed enforcement of the two-midnight rule.
The agency declared that it would postpone enforcement of the rule until April 30. CMS intended for the delay to give the full Congress more time to pass a bill that would repeal the Sustainable Growth Rate formula, Healthcare Dive reported.
The publication said it is likely that the Senate, which has yet to vote on the SGR bill already approved by the House of Representatives, would pass the bill when it reconvenes from its spring recess later this month.
Under the two-midnight rule, Medicare will not reimburse hospitals at inpatient rates for treatment that does not span two midnights. However, many hospitals have objected to the actions of recovery audit contractors (RACs), who in some cases may determine that the inpatient admission wasn't necessary and the hospital should have provided treatment on an outpatient basis. That in turn has led to CMS suspending review of all inpatient claims submitted by hospitals to the Medicare program between October 1, 2013 and April 30 of this year. Hospitals have also appealed many claims denied by RACs, leading to heavy congestion in the federal administrative court system and a delay in settling claims that could potentially last for years.
CMS also offered to settle claims in dispute between RACs and hospitals, paying 68 cents on the dollar. Although the settlement offer has received wide attention in the healthcare sector, it has also drawn scorn from some hospital quarters.
Meanwhile, the American Hospital Association has also taken legal action against the two-midnight rule.
In its announcement about delaying the enforcement of the two-midnight rule, CMS said that settlement talks with the hospitals are ongoing.
To learn more:
- read the CMS announcement
- check out the Healthcare Dive article