CMS issues revised guidelines for ‘two-midnight’ rule

Editor's Note

The Centers for Medicare & Medicaid Services (CMS), on January 1, issued revised guidelines on “Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After January 1, 2016.”

Under the revised exceptions policy for admissions not meeting the two-midnight benchmark, Part A payment may be appropriate on a case-by-case basis where the medical record supports the physician’s determination that the patient requires inpatient care, despite the lack of a two-midnight expectation.

CMS will consider complex medical factors such as history and comorbidities, the severity of signs and symptoms, current medical needs, and the risk of an adverse event to determine whether the medical record supports the need for inpatient hospital care.