Health Information Management

News: AHA joins 2-midnight rule complaint against CMS

CDI Strategies, April 24, 2014

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The American Hospital Association (AHA) along with four hospital associations and several hospitals filed two complaints April 14 in opposition of CMS’ 2-midnight rule for inpatient admissions, according to an AHA press release. 

The first complaint challenges “unlawful Medicare policies,” and claims the 2-midnight rule creates a burden on hospitals because it denies hospitals appropriate Medicare reimbursement for reasonable, medically necessary care. It is unfair for CMS to deny hospitals Medicare Part A payment for inpatient admissions that do not span two midnights, according to the complaint. The AHA also argued that written physician orders should not be required for inpatient admission.

The first complaint also goes after the one-year timely filing requirement for Part A to B rebilling set forth by the 2014 IPPS Final Rule. The timely filing limit makes it nearly impossible for hospitals to receive Part B payment for denied Part A claims because Recovery Auditors don’t often review and deny these claims until one year after the date of admission, according to the complaint.

The second complaint took aim at CMS’ 0.2% reduction of hospital payments for Medicare beneficiary discharges occurring on or after October 1, 2013. This cut is “unlawful” and “deeply flawed” because CMS underestimated the number of encounters that would shift from inpatient to outpatient and overestimated the number of cases that would shift from outpatient to inpatient, the AHA contends. Hospitals will continue to suffer if CMS does not reverse the reduction in payments, according to the complaint.

In filing the complaints against HHS, the AHA was joined by:

  • The Hospital and Health System Association of Pennsylvania
  • New Jersey Hospital Association
  • Healthcare Association of New York State
  • Greater New York Hospital Association
  • Wake Forest Baptist Medical Center in Winston-Salem, N.C.
  • Einstein Healthcare Network in Philadelphia
  • The Mount Sinai Hospital in New York, N.Y.
  • Banner Health in Phoenix

Editor’s Note: This article was originally published in the HIM-HIPAA Insider.



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