February 3, 2014

CMS Delays Two-Midnight Rule, Announces February 4 Open-Door Forum

Late on Friday, January 31, 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 for MACs and red 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 education sessions sponsored by CMS.

The agency announced earlier last week that it would hold a conference-call only Special Open-Door Forum on the Two-Midnight Rule on Tuesday, February 4, from 1:00 – 2:00 pm EST.  CMS describes 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,” i.e., the Two-Midnight Rule.

There is no pre-registration for the call.  The call-in number is (877) 251-0301, with conference ID 47736519.  We recommend you dial-in several minutes early to secure a line.  PYA consultants will participate in the call and report important developments relating to the Two-Midnight Rule.

Last month, on January 14, CMS conducted a 90-minute Medicare Learning Network National Provider Call on the Two-Midnight Rule.  The slide presentation is available here and the 32-page written transcript can be found here.

During the January call, CMS officials 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 for several minutes.

CMS has instructed its contractors to adhere to the guidance provided during that Open-Door Forum when applying the Two-Midnight Rule.

The slide presentation, informed by the transcript from the January 14 call and supplemented by the upcoming call on February 4, will give hospitals the most up-to-date training tools for those working the front line on the Two-Midnight Rule.  Given the flood of information from public and private sources on the subject over the last few months, it will be a relief to have a single source of reliable directives.

CMS encourages providers with specific questions or comments regarding the Two-Midnight Rule to submit them to IPPSAdmissions@cms.hhs.gov.

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.

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