1. 2 Midnight“New”Rule By Rebecca Corzine Tarr RN, CPA Executive Vice President MedPerformance LLC

2. 2 Midnight“New”Rule • Effective last October, CMS began requiring certain verbiage and expanded the components that are required to be documented and fully authenticated prior to discharge, in the medical record for an acute care hospital inpatient admission, see CMS-1599-F. The order must specifically state: • Admit to Inpatient, • Admit as an Inpatient or, • Admit for Inpatient services.

3. 2 Midnight“New”Rule • In addition, there are three other components that must be present: • The physician must specifically state the patient’s expected length of stay in the hospital will be at least two (2) midnights. • The physician must identify the reason/rationale for the acute care inpatient admission and include the plan of care, which indicates why the expected LOS is at least two midnights. • The physician must document a preliminary discharge plan.

4. 2 Midnight“New”Rule • The patient must actually stay in the hospital at least two midnights. (As of now, CMS is allowing the patient to be in an outpatient observation status for one of the two midnights.) • The main exception to the above time requirements is if a patient is undergoing a procedure that is on the CMS “Inpatient Only” list. • However, even if the physician documentation meets all of the above requirements, if medical necessity is not met (as defined by CMS), the inpatient admission will be denied. • This means that not only will the hospital be denied payment for the care that was rendered; it also may mean that the physician’s inpatient claim will be denied.

5. 2 Midnight“New”Rule • What is your facility’s plan? • Written procedures for: • Case Managers • Physicians • Patient Access (Registration) Reps • PFS Medicare Billers • Coders • Consider CM – Physician “team” for inpatient documentation • May need “runners” if hybrid system or all paper

6. 2 Midnight“New”Rule • What is your facility’s plan? • Consider pre-bill edit to hold Medicare inpatient claims that are zero, one and two-day stays. • Case Manager Review prior to billing. • Trend deficiencies in documentation and LOS. • Educate Physicians & Extenders. • Peer Review and/or CEO involvement if necessary.

7. 2 Midnight“New”Rule • Key takeaways: • Inpatient Admission Order – authenticated PRIOR to discharge. • Expected & Actual LOS – at least 2 midnights, reason for hospitalization, plan of care and discharge plan must be somewhere in the medical record. • Medical necessity must be met.

8. Thank You Rebecca Corzine Tarr Executive Vice President MedPerformance LLC MedPerformance.com BeckyTarr@me.com (813) 786-8974