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CMS Posts Additional Two-Midnight Guidance

The Centers for Medicare & Medicaid Services (CMS) posted Feb. 24 additional guidance on the two-midnight policy. In the guidance, CMS stated that Medicare administrative contractors (MACs) must re-review all claim denials to date under the probe and educate process. CMS encouraged providers to work with their MAC to determine if a denied claim has been re-reviewed before submitting an appeal request. CMS also stated that it will accept appeals outside of the 120-day time frame for claims that were denied on or before Jan. 30.

In addition, CMS released a new document that provides initial data collected from the inpatient hospital probe and educate reviews. According to the document, common examples for denying claims made during the probe and educate period include the following:

  • The medical record did not include an order from a physician to admit the patient as an inpatient and failed to support an expectation of a two-midnight stay.
  • The patient underwent a procedure for which treatment and discharge typically occur in fewer than two midnights.
  • The patient experienced a short hospital stay for a medical condition.

Please contact Xiaoyi Huang, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with feedback or questions.

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