Healthcare News: CMS finalizes 2-midnight rule changes

Why This Topic Matters

The rule affects how hospitals document and support inpatient admissions for Medicare beneficiaries and how those cases are reviewed. Understanding the policy shift is important for organizations managing admission status, compliance, and audit preparedness.

Article Sections

1. CMS finalizes 2-midnight rule changes

   Overview of CMS action in the 2016 OPPS final rule and the transition in responsibility for education and enforcement. The section also notes the effective timing of the change and stakeholder input.

2. Policies for stays expected to last less than two midnights

   Discussion of CMS policy framework for shorter expected stays, including case-by-case review and documentation expectations for inpatient admission decisions.

3. Policies for patients staying more than two midnights

   Summary of the unchanged framework for longer expected stays and the related medical record support expectations.

4. QIO review and Recovery Auditor referrals

   Explanation of the new review pathway beginning January 1 and the general circumstances under which cases may be referred onward for additional review.