Jan. 23—On Jan. 22, hospital associations and systems sought an expedited review of their challenge to the so-called two-midnight rule and its anticipated reduction in hospital payment.
The groups involved are the American Hospital Association; hospital associations of Greater New York, New York State, New Jersey, and Pennsylvania; hospitals from Banner Health and Einstein Healthcare Network; Wake Forest University Baptist Medical Center; and The Mount Sinai Hospital. Their appeal to the Provider Reimbursement Review Board (PRRB) asked for expedited judicial review because the PRRB “lacks the power to grant the providers’ requested relief.”
The two-midnight rule says that for inpatient hospital admissions to be eligible for Medicare Part A payments, physicians must document that they expect the beneficiary to require a stay of at least two midnights and admit the patient based on that expectation. On Sept. 5, 2013, the Centers for Medicare & Medicaid Services provided guidance for interpreting the rule.
For an overview of the two-midnight rule, consult HFMA's overview of the final 2014 Inpatient Prospective Payment System Rule and the two-part webinar “CMS's Two-Midnight Rule: How Will It Impact Short-Stay Cases?"—Part I and Part II.
Publication Date: Thursday, January 23, 2014