Tuesday, November 10, 2015

CMS Finalizes Updates to Two-Midnight Rule

James Michel

Last week, CMS published its final rule on the Fiscal Year (FY) 2016 Hospital Outpatient Prospective Payment System. You can access CMS' fact sheet on the rule here . CMS relaxed some portions of the rule originally proposed earlier this year dictating what admitting physicians must document in order to justify payment as an inpatient. Also of note is CMS' decision to use Quality Improvement Organizations to conduct initial patient status reviews to determine payment appropriateness under Medicare; these reviews were previously conducted by Recovery Audit Contractors or Medicare Administrative Contractors.

The American Hospital Association has praised the finalized changes. To read the full rule, click here . To read a great summary of the changes to the two-midnight rule, click here. Please email AHCA’s James Michel with any questions.

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