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CMS Calls for review of “Two-Midnight” Denials

CMS has ordered the Medicare Administrative Contractors (MACs) to re-review all denied claims for admissions under the “two-midnight” rule. The Final Rule CMS-1599-F has proven to be difficult to implement. On 2/24/14, CMS issued new guidance, whereby CMS is waiving the timeframe for filing redetermination requests for appeals received before 9/30/14 for claims denied before 1/30/14 under the Probe and Educate process. The MACs are re-reviewing all claim denials under the Probe & Educate process to ensure claim decisions and education is consistent with recent clarifications from CMS. With CMS calling for the MACs to re-review denied “two midnight” admissions, documentation of medical necessity remains important.

Here’s a link to the CMS guidance:

Generally the “two-midnight” rule requires patients to remain in a hospital bed to qualify for inpatient care. As a result of claims being denied that may not be supported by recent updates, CMS is allowing for handling outside of the normal appeal process for denied claims.

By Denise Bloch

Denise Bloch

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