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Two-Midnight Rule Under Scrutiny

Written by: Mediware Bloggers on Monday, June 19, 2017 Posted in:

In a recent report, the Office of Inspector General (OIG) expressed concern that the two-midnight rule isn’t working. The OIG found several weaknesses in hospital billing under Medicare’s two-midnight rule, including a large number of short inpatient stays.

Upon studying outpatient stays, the OIG found beneficiaries were paying more but receiving less. Beneficiaries of outpatient stays experienced greater cost but more limited access to skilled nursing facility (SNF) services compared to those of inpatient stays. The OIG recommended CMS find ways to equalize cost-saving protections and access to SNF services between outpatient and inpatient beneficiaries.

The two-midnight policy was implemented in 2013 to provide clarity to curb short inpatient and long outpatient stays. The rule establishes inpatient payment is appropriate if the admitting practitioner supports a reasonable expectation of a hospital stay crossing two midnights.

Use MediLinks to track patients’ length of stay and ensure the correct billing processes are followed.

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