Health Information Management

News: '2-Midnight' audit probe timeline extended

CDI Strategies, February 13, 2014

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Medicare Administrative Contractors can continue their “probe and educate” audits related to the “2-Midnight Rule” through September 30, CMS recently announced. The probe and educate period was originally slated to end March 31, 2014. The idea behind the pre-payment reviews is to identify common errors and communicate those problem areas back to the facilities to facilitate improvement.

Additionally, CMS updated guidance related to the “2-Midnight Rule” to further clarify aspects of what constitutes “physician certification.” This essentially means that the admitting physician must “certify” that the services the patient requires need to be provided on an inpatient basis (i.e., are medically necessary). “The physician certification, which includes the practitioner order, is considered along with other documentation in the medical record as evidence that hospital inpatient service(s) were reasonable and necessary,” the guidance states.
The seven page document outlines requirements related to the content, timing, and format of the certification.
Editor’s Note: Get additional insight into the recent release from HCPro’s Medicare Boot Camp instructors in the eNewsletter Medicare Insider.


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