A confusing Medicare policy that creates a “two-midnight” stay benchmark to distinguish between observation care and short inpatient admissions has been partially delayed a third time.
The Centers for Medicare & Medicaid Services (CMS) said Friday it is extending the two-midnight rule’s “probe and educate” transition period to the end of the federal fiscal year, Sept. 30. Full enforcement of the rule was supposed to begin in April.
The rule stipulates an inpatient admission will be presumed reasonable and necessary upon a physician’s expectation that a Medicare beneficiary will spend more than two midnights in a hospital, while shorter stays will generally be considered outpatient or observation care.
U.S. Rep. Jim Gerlach, R-Pa., introduced a bill in December that sought to delay the full roll-out of the two-midnight rule until Oct. 1, the beginning of the next federal fiscal year.
The AMA “strongly opposes” the two-midnight rule, said AMA President Ardis Dee Hoven, MD, citing the increased amount of documentation physicians will have to file and lack of clarification and protection from retroactive payment denials and recoupments.
“We recognize these issues are causing tremendous difficulty for physicians and patients, and we will continue to work with stakeholders to pursue workable solutions during the additional time afforded by the delay issued by CMS,” she said.
CMS issued the rule in August, and the policy technically went into effect Oct. 1, 2013, but CMS has continued to issue delays in key enforcement provisions in response to complaints from physicians, hospitals and Medicare patients about the complicated policy.
