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Changes to 2-midnight rule included in 2016 OPPS final rule

Case Management Insider, November 17, 2015

CMS finalized proposed changes to the 2-midnight rule in its 2016 OPPS final rule.

The change softened CMS’ original stance giving physicians a little more flexibility when it comes to ordering inpatient admissions, even when the stay is expected to be less than two midnights. This is allowed if the physician can prove that the stay is justifiable from a medical standpoint and if the physician clearly documents his or her thinking on the case.

The rule also confirmed that education and enforcement of the 2-midnight rule will shift from Recovery Auditors to Quality Improvement Organizations (QIO).

“Hospitals appreciate the certainty that stays of at least two midnights are inpatient, with stays of less than two midnights also considered inpatient based on physician judgment,” said American Hospital Association Executive Vice President Tom Nickels in a statement. “We look forward to working with the [QIOs], which are not paid on a contingency fee basis like the bounty hunter RACs, and to a more fair auditing process.”
Stay tuned for more details in an upcoming issue of Case Management Monthly.

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