"Two-Midnight" Rule Enforcement Delay Extended

CMS has extended the partial enforcement delay of the controversial "two-midnight" rule, which was originally set to expire on September 30, to December 31.

The Medicare rule requires patients be hospitalized for two midnights before they are deemed eligible for inpatient care. This can allow beneficiaries to qualify for skilled nursing coverage.

This means that Recovery Audit Contractors will not conduct post-payment reviews for claims that have admission dates between October 1 and December 31. Quality Improvement Organizations (QIOs) will conduct reviews to determine whether inpatient status is appropriate during that time period.

As of January 1, initial status reviews will be handled by QIOs, with Recovery Audit Contractors conducting follow-up reviews when the QIOs refers them.

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