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Providers Blast CMS on Two-Midnight Rule

Christopher Cheney, for HealthLeaders Media, July 1, 2014

One of the hottest healthcare controversies—the two-midnight rule—boils over in comments submitted to federal officials regarding the 2015 Inpatient Prospective Payment System rules.

For the past year, the federal Centers for Medicare & Medicaid Services have been at odds with healthcare providers over a proposed standard for drawing the line between outpatient and inpatient status.

Under the proposed "two-midnight rule," most hospital stays lasting less than two midnights in duration would be reimbursed at outpatient rates through Medicare B. Longer stays requiring hospital admission would be reimbursed at the more lucrative Medicare A inpatient rate.

Congress has placed the two-midnight rule on hold until early 2015. And CMS has provided no new guidance about the patient status regulation in the proposed version of the 2015 Inpatient Prospective Payment System rules released May 15.

But the issue remains a prime concern for providers.

From the institutional to the individual level, providers have raised howls of protest in comments filed with CMS regarding the proposed 2015 IPPS regulations. The deadline to submit comments to CMS was June 30.

In its comment letter to CMS dated June 20, officials at the Michigan Health and Hospital Association said it has been—and remains—opposed to the two-midnight rule since its inception last summer.

"The MHA continues to believe that in cases where a physician or other qualified and licensed practitioner has determined that a patient met national guideline criteria to be admitted as a hospital inpatient, the care provided should be covered and paid by Medicare Part A," the Michigan officials wrote.

"The decision on the appropriate setting of care can best be made by the patient's physician based on the patient medical history, co-morbidities, severity of signs and symptoms, current medical need and the risk of an adverse event without regard to any 'guesses' about how long a patient will remain in the hospital. This policy has resulted in much confusion over the past year for hospital staff, patients, and their families, and can have serious financial implications."
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