In the final payment rule for fiscal year 2014, CMS codified a “Two-Midnight Rule” that applies to surgical procedures, diagnostic tests, and other treatments provided in acute care inpatient hospital facilities, long-term care hospitals, critical access hospitals, and inpatient psychiatric facilities.
This rule establishes both a benchmark for physicians to determine when an inpatient admission will likely be viewed as appropriate for Part A payment, and a presumption for medical review contractors to use in conducting post-payment audits. For the benchmark, the rule specifies that Part A payment is generally appropriate if, at the time of an inpatient admission, the physician expects that the stay will cross two midnights. The rule also specifies that medical review contractors should presume that claims for inpatient stays lasting longer than two midnights are generally appropriate for Part A payment.
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