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Hospital Execs Hope for Two-Midnight Rule Repeal

Rene Letourneau, for HealthLeaders Media, April 28, 2014

Along with creating economic concerns for Medicare beneficiaries, the two-midnight rule adds difficulty for physicians, Johnson says.

"CMS posits that admitting a patient to a hospital requires a complex judgment call, but the ruling seems to place requirements around the definition of inpatient that in fact remains unclear and conflicted. Therefore, expecting a physician to predetermine length of stay and type of care status—observation, outpatient, or inpatient—seems to fall outside the best interest of the patient, both clinically and financially. For example, as an inpatient, the patient is obligated to pay his or her inpatient deductible, [but] as an outpatient, the patient pays 20% of the Medicare allowable amount, plus self-administered drugs."

"[The ruling also] jeopardizes the provider's ability to order, document, and code accurately 100% of the time to ensure the allowable reimbursement for physician and hospital services delivered for treatment," he adds.

Johnson says CMS should look for ways to make the billing process less complex, not more.

"With more collaboration and decision-making involving the best interests of patients and providers, CMS can find ways to make the requirements less complicated, and in turn, ease the patient experience, as well as the clinical and billing processes for all," he says. "In the spirit of what's best for our patients and what's best for the providers' ease of making sound judgments and the documentation process that follows, I am hopeful the rule will be overturned."

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1 comments on "Hospital Execs Hope for Two-Midnight Rule Repeal"


Nadia White (4/29/2014 at 12:01 PM)
Excellent article! You hit the nail on the head when you cited that a patient's healthcare should not be based on how long they are in the hospital, but upon the physician's clinical judgment. We're losing our ability to appropriately treat patients based on arbitrary rules designed with cost savings in mind rather than the patient's health. Thank you so much for this excellent article!