CMS Delays Two-Midnight Rule; New Guidance Available

Late January, the Centers for Medicare & Medicaid Services (CMS) announced on its Inpatient Hospital Reviews webpage that the agency was extending the “Probe and Educate” review process for CMS-1599-F, commonly known as the Two-Midnight Rule, by six months to September 30, 2014.

In short, this means green light for MACs and red light for RACs:

  • Medicare Administrative Contractors (MACs), the private insurance companies that process Medicare claims, will continue to select claims for review with dates of admission between March 31, 2014, and September 30, 2014.  MACs will continue to review and deny claims found not in compliance with the Two-Midnight Rule.
  • MACs will continue to hold educational sessions with hospitals through September 30, 2014.
  • Generally, Recovery Audit Contractors (RACs) and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013, through October 1, 2014.

This delay comes as welcome news for hospitals still working to implement the Two-Midnight Rule, as will the announcement of new reference materials and education sessions sponsored by CMS.

On January 14, CMS conducted a 90-minute Medicare Learning Network (MLN) National Provider Call on the Two-Midnight Rule.  The call provided an overview of the Two-Midnight Rule, presented six case scenarios explaining how the rule should apply in specific circumstances, and answered providers’ questions.  The slide presentation is available here and the 32-page written transcript can be found here.  CMS has instructed its contractors to adhere to the guidance provided during that Open-Door Forum when applying the Two-Midnight Rule.

CMS held a Special Open-Door Forum on the Two-Midnight Rule February 4.  The agency billed this event as “a follow-up call to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission, and medical review criteria.”  Information from the February 4 telephone conference will be available on the Special Open-Door Forum webpage.

CMS has announced a Medicare Learning Network Connects National Provider Call to be held February 27, from 2:30 to 4:00 p.m. ET.  According to CMS, “[t]his call will provide an overview of the inpatient hospital admission and medical review criteria [for the Two-Midnight Rule].  The call will address frequently asked questions received to-date and answer questions from the public. The target audience for this call includes hospitals, physicians and non-physician practitioners, case managers, medical and specialty societies, and other healthcare professionals.”  Information regarding the call is available here.

Finally, CMS encourages providers with specific questions or comments regarding the Two-Midnight Rule to submit them to

PYA professionals can analyze the financial impact of the Two-Midnight Rule on your hospital, help you and your staff understand the specific regulatory requirements, and assist you in developing and implementing compliance strategy associated with the Two-Midnight Rule.

For more information, contact the PYA professionals listed below at (800) 270-9629.

Denise Hall-Gaulin

Denise Hall-Gaulin


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