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Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
Enforcement of Medicare’s two-midnight rule has been delayed until Oct. 1, officials at the Centers for Medicare & Medicaid Services announced.
The two-midnight rule calls on doctors and hospitals to admit patients undergoing surgical procedures, diagnostic tests, or other treatments if they anticipate that the patient will be in the hospital for two midnights. The change is aimed at clarifying when a patient should be admitted vs. being kept in observation status. The rule was originally released in August 2013.
The delay, announced Jan. 31, will provide more time to educate physicians and hospitals about the changes, according to the agency.
Until then, Medicare Administrative Contractors (MACs) will review claims with admission dates between March 31, 2014, and Sept. 30, 2014, and deny those claims that are out of compliance with the rule. The MACs will review 10 claims for most hospitals and 25 for large hospitals and conduct additional education with hospitals, according to the CMS.
But Recovery Auditors will not perform postpayment audits of claims until Oct. 1.
"The delay only postpones the inevitable," said Dr. Bradley E. Flansbaum, a hospitalist in New York City and a member of the Society of Hospital Medicine’s public policy committee. "We still want clarity on what the rule means and how to implement it."
The SHM has asked the CMS to provide more information on how and why time in an intensive care unit could be considered observation/outpatient.
Also, the SHM is seeking guidance on how physicians should handle cases in which the expected length of stay is longer than two midnights, but the patient recovers more quickly. The rule indicates that those patients should retain their inpatient status for payment, but physicians likely will face pressure to change that status back to observation, the SHM noted in a letter to CMS.
Despite the lingering questions, Dr. Flansbaum said there’s enough information available for physicians to start preparing for the change. He advised doctors to use the 6-month delay wisely and begin working as if the postpayment audits were already underway.
CMS, as well as the MACs, will hold educational sessions with hospitals through the end of September. On Feb. 27, CMS will host a call for hospitals, physicians, case managers, and other health care providers to answer frequently asked questions about the two-midnight rule.
The agency also issued guidance that outlines what information should be included in the physician certification of inpatient services; the timing of physician certification and discharge orders; who can sign the inpatient certification; the format required for certification; and the timing, content, and specificity required with an inpatient admission order.
On Twitter @maryellenny
