Health Information Management

News: 2-midnight changes, OPPS rule finalized

CDI Strategies, November 12, 2015

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

For stays in which the physician expects the patient will need less than two midnights of hospital care, inpatient admission may be allowed on a case-by-case basis, according to the 2016 OPPS final rule.  

Whether or not inpatient admission is needed will be determined by the judgment of the admitting physician, provided information in the medical record supports the diagnosis and the medical necessity of the admission. The documentation must support the admission, and will be subject to review by Recovery Auditors to Quality Improvement Organizations (QIO).

CMS expects inpatient admission for minor surgical procedures to be unlikely, and will prioritize those cases for medical review. For hospital stays expected to last two midnights or longer, CMS policy remains unchanged. For providers who worked with the physician staff and currently see good documentation, this change is likely to have little or no impact.  

CMS finalized its proposals regarding the 2-midnight rule, including moving responsibility for rule enforcement and education from QIO. This latter change occurred on October 1, 2015.

Editor’s Note: This article was originally published in JustCoding.



Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular