Lexology November 17, 2023
The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. However, CMS also stated that care spanning two midnights is not “presumed” appropriate for an inpatient level of care under Medicare Advantage, as it is under traditional Medicare Part A. In other words, Medicare Advantage plans are still free to audit claims in accordance with their contracts with providers, meaning that the two-midnight rule may not be as helpful to hospitals under Medicare Advantage as it is under traditional Medicare.
Background
Originally published in 2013 and amended in 2016, the two-midnight rule provides that inpatient services...
Today's Sponsors
Today's Sponsor