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OIG continuing to target vulnerabilities under 2-midnight rule

Physician Practice Insider, June 12, 2017

The Office of Inspector General’s (OIG) recently released semiannual report says vulnerabilities remain under CMS’ two-midnight hospital policy as the agency recently concluded a study into hospital reporting of such stays.

During a six-month reporting period that ended March 31, OIG identified several vulnerabilities in hospital billing under Medicare’s two-midnight policy. Weaknesses the OIG found included a large number of potentially inappropriate short inpatient stays and an increased number of beneficiaries in outpatient stays paying more and having limited access to skilled nursing facility (SNF) services compared with inpatients, the report says. OIG noted that these findings raise concerns about the cost to Medicare and beneficiaries.

“We recommended that CMS conduct analyses like those in this evaluation to target their oversight. We also recommended that CMS explore ways to ensure that beneficiaries receiving hospital care in outpatient status have similar cost-sharing protections and access to SNF care as beneficiaries receiving similar hospital care in inpatient status,” the report says.

CMS concurred with the OIG’s findings. The two-midnight rule was implemented by CMS in 2013 and establishes that inpatient payment is appropriate if physicians expect patient care to last at least two midnights.

To read about more OIG studies completed between Oct. 1, 2016, and March 31, 2017, see the full report.

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