A bipartisan group of more than 100 federal lawmakers led by Rep. Allyson Schwartz (D-Pa.) has asked CMS to delay for six months the implementation of a regulation that generally considers inpatient admissions spanning two midnights as qualifying for payment under Medicare Part A.
CMS included the new regulation in its final rule on 2014 Medicare inpatient prospective payment system rates. In a letter to CMS Administrator Marilyn Tavenner, the lawmakers said they appreciate the effort to clarify that inpatient admissions are reasonable and necessary for Medicare beneficiaries who require more than a one-day stay or who need treatment specified as inpatient only. Under the policy, stays that last less than two midnights should have been treated and billed as outpatient services.
Although the lawmakers agree with the goal of only paying for medically necessary inpatient services, they are concerned enforcement of the "two midnights" regulation could lead to higher out-of-pocket costs for patients, unfairly denied hospital claims and providers getting undercompensated for providing medically necessary services that don't meet the new criteria.
In order to address those concerns, Rep. Schwartz and the other legislators have asked CMS to review the regulation and make modifications to the admission and medical review criteria.
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