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Physician Law Blog

We provide insights and analysis for physicians, nurses, chiropractors, dentists, physical therapists and other health professionals on issues impacting their practices.

Physician Law Blog
February 28, 2014

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.