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CMS to Hold Open Forum on Two Midnight Benchmark for Inpatient Hospital Admission

Posted on 9/25/2013 by NTOCC ® in Public Policy Updates

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced that it will be holding a special open door forum, “Discussion of the Hospital Inpatient Admission Order and Certification 2 Midnight Benchmark for Inpatient Hospital Admission” on Thursday, September 26th from 2:00pm ET– 3:00pm ET. The conference call will allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the proposed FY 2014 Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital Prospective Payment System Payment Rule.

The “two midnights” provision clarified when hospitals should admit patients and when patients should be placed in observation status. CMS states that if physicians expect beneficiaries to stay in the hospital for at least two midnights, CMS will direct payment contractors to presume an inpatient stay is appropriate. Hospitals have expressed concern that the arbitrary timeline will overrule physicians judgment, and as a result hospitals may be unfairly subject to denied claims or made vulnerable to unnecessary RAC audits.

By way of background, Congress and provider and patient groups have raised concerns about how hospitals use observation stays and short inpatient stays.  Under current law, to qualify for the Skilled Nursing Facility (SNF) benefit, Medicare requires that the patient must have an inpatient stay of three or more consecutive days.  However, hospitals are increasingly classifying patients as “outpatients” despite the fact that they stay for many days and nights and receive the care and medical services as if they were inpatients.  These beneficiaries face greater financial liability towards accessing skilled nursing care, and many are forced to forgo care because the costs are too burdensome.

As you may recall, NTOCC provided comments to CMS on the proposed inpatient rule regarding this issue and highlighted the challenges for Medicare beneficiaries who are hospitalized under observation status, but not formally admitted as an inpatient, and then need skilled nursing facility (SNF) care.  While NTOCC supported CMS providing clarity on when a beneficiary would appropriately qualify for admission as an inpatient, as presumably that would decrease the number of beneficiaries inappropriately held for multiple days under “observation status,” NTOCC also urged CMS to further expand the type of patient classification which would qualify for the SNF benefit to ensure that time spent in observation stay could be counted toward meeting the three-day prior inpatient stay requirement needed to qualify for Medicare SNF coverage.

Click here for the CMS on the Forum for more information.
Special Open Door Participation Instructions:
Dial: Participant Dial-In Number(s): 1-800-837-1935 Conference ID # 68257949