Feb. 4—Medicare officials underscored the need for admitting physicians to sign admission orders in order for the program to pay hospitals for inpatient care, during a Tuesday conference call with hospital officials aimed at clarifying the so-called two-midnight rule.

The new Medicare admissions rule, which the Centers for Medicare & Medicaid Services (CMS) recently delayed enforcement of until Oct. 1, 2014, established new inpatient hospital admission requirements under Medicare Part A. The new rules required physicians to document that they expect the beneficiary to require a stay of at least two midnights and admit the patient based on that expectation.

CMS officials clarified that the certification required from the admitting physician under the rule must include a signature by the time of discharge. One hospital official on the call said that the requirement would result in longer patient stays due to the logistics of bringing physicians who have verbally ordered the admission over the phone into the hospital to sign the document by the time the patients was ready for discharge.

Daniel Schroeder, a member of the division of acute care at CMS, said the signature of the admitting physician is needed by the time of discharge in order to submit for Medicare Part A reimbursement. Otherwise, hospitals would have to seek reimbursement for such patient care as lower-paying Part B outpatient care.

However, a single signature of an admitting physician at the end of a medical record would be sufficient to certify all of the clinical information entered by another clinician who lacked admitting privileges but initiated the admission, he said.

Unaffected Provisions

CMS officials also clarified that the agency’s recent extension of an enforcement moratorium of the two-midnight rule by Medicare contractors did not apply to all contract auditors. For example, such admissions may be included among a randomly selected sample of claims by a comprehensive error rate testing contractor.

Schroeder also noted that the latest two-midnight rule did not change CMS policy designating the start of admission as the time that an admission order is issued. On the other hand, further treatments could follow the signing of a discharge order.

Not yet finalized, said the CMS officials, was guidance on how hospitals should bill under the two-midnight rule for inpatient care of patients transferred from another hospital.

The agency officials also were unable to provide an immediate answer for several other questions, which they said CMS would address in future guidance. Providers also could send additional questions to ippsadmissions@cms.hhs.gov.

Publication Date: Tuesday, February 04, 2014