Health Information Management

News: OPPS proposed rule tweaks 2-midnight rule

CDI Strategies, July 9, 2015

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CMS attempted, once again, to resolve ongoing patient status confusion—this time in its Outpatient Prospective Payment System (OPPS) proposed rule. If included in the final rule, physicians can admit patients to the hospital even if they do not expect the individual to require more than two-night stay to be safely discharged.

It also shifted responsibility for educating physicians and enforcing the 2-midnight rule will shift to Quality Improvement Organizations (QIO) from Recovery Auditors. However, CMS warned that it expects sort stays for minor surgical procedures or hospital care to be rare and will monitor these types of admission to prioritize them for medical review.

CMS also plans to sharply accelerate its push toward a true prospective payment system with a new comprehensive ambulatory payment classification (C-APC) system and extensive APC consolidation and reconfiguration.

This could have potential implications for CDI since, like the shift to MS-DRGs in 2007, this bundles payments and could provide a window for increased involvement in CDI on the outpatient side.

Other proposed adjustments include:

  • Packaged services
  • Device Pass-through Process
  • Ancillary services in ASC codes
  • Partial Hospitalization Programs

CMS will accept comments on the proposed rule until August 31, 2015, and will respond to comments in a final rule to be issued on or around November 1, 2015. The proposed rule will appear in the July 8 issue of the Federal Register.

Editor’s Note: This article was based on information from a statement released by CMS, and the following article originally published on the HCPro Website “CMS continues packaging, tweaks 2-midnight rule in 2016 OPPS final rule.”



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