Becker's Healthcare May 16, 2024
In 2024, Medicare Advantage plans must provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care for at least two midnights, otherwise known as the two-midnight rule.
The rule was included in the 2014 Medicare inpatient prospective payment system final rule. In 2023, CMS clarified in its final rule that MA plans must also follow the two-midnight rule, its case-by-case exception and the inpatient-only list beginning in 2024.
“Whether the admission actually crossed two midnights is not a factor in the inpatient admission criteria,” CMS wrote in Feb. 6 guidance. “An MA organization may evaluate whether the admitting physician’s expectation that the patient would require hospital care that crosses two-midnights was reasonable based...
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