2 Midnights / risks

' "Documenting the Decision to Admit expecting a 2 midnight hospital stay" for all medicare and medicare advantage/HMO patients  is best practice  as part of hospital admission allowing hospital to bill services under Medicare Part A hospitalization vs Part B -outpatient with higher out of patient costs and not meeting Medicare SNF requirement avoiding denials.  Your Utilization Review department should have sent procedure notice to physicians, might be good line item to review at next attending meeting.

See CGS Medicare Intermediary Revised: 03.19.24

The Two-Midnight Rule: Preventing Denials

Quote

What documentation should the physician provide to support the expectation of a hospital stay that spans 2 or more midnights was reasonable?

The decision to admit a beneficiary as an inpatient is a complex medical judgment that can only occur after the physician considers various factors including (but not limited to):

• Beneficiary's age
• Disease processes
• Comorbidities
• Potential impact of sending the beneficiary home

Clarification of the Two-Midnight Rule: A Win for Physician Advisory

Hmmm, that's actually part of the core admission orders in our Epic order set...it asks specifically that the provider certifies that this is an admission that will include at least 2 midnights, otherwise, we could say no and make the assessment that the admission is an Observation (Obs) only. Our CM's also make sure that if we discharge patients before the 2 midnight rule that we change the status to Obs.