News: 2-midnight changes, OPPS rule finalized

For stays in which the physician expects the patient will need less than two midnights of hospital care, inpatient admission may be allowed on a case-by-case basis, according to the 2016 OPPS final rule.  

Whether or not inpatient admission is needed will be determined by the judgment of the admitting physician, provided information in the medical record supports the diagnosis and the medical necessity of the admission. The documentation must support the admission, and will be subject to review by Recovery Auditors to Quality Improvement Organizations (QIO).

CMS expects inpatient admission for minor surgical procedures to be unlikely, and will prioritize those cases for medical review. For hospital stays expected to last two midnights or longer, CMS policy remains unchanged. For providers who worked with the physician staff and currently see good documentation, this change is likely to have little or no impact.  

CMS finalized its proposals regarding the 2-midnight rule, including moving responsibility for rule enforcement and education from QIO. This latter change occurred on October 1, 2015.

Editor’s Note: This article was originally published in JustCoding.