The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal for long-awaited changed in its controversial Medicare “two-midnight rule.”

cmsThe changes, part of the agency’s proposed 2016 Medicare outpatient prospective payment system regulation released last week, include:

  • changes in the standards by which inpatient admissions qualify for Medicare Part A payments
  • a shift in responsibility for enforcement of the regulation, with Quality Information Organizations (QIOs) taking over from Recovery Audit Contractors (RAC auditors).
  • changes in how long hospitals have to rebill for Medicare Part B services
  • time limits on auditor requests for additional information about claims
  • new limits on when recovery auditors must complete complex reviews and how long they must wait before sending claims to Medicare administrative contractors (MACs) for adjustment so providers have a reasonable opportunity to comment on preliminary findings.

CMS has published a fact sheet on the proposed changes in the two-midnight rule; find that fact sheet here. The two-midnight rule changes are part of a broader proposed regulation governing Medicare outpatient payments to providers in 2016. Find that proposed regulation here.