CMS Two Midnight Rule

The 2 midnight rule is designed to identify the appropriate level of care for short term stays or episodes in acute care, critical access and long term hospitals and to reimburse accordingly. The rule designed to save money by payment through Medicare part B instead of A is seen by many consumers and providers as both unclear and a cost shift from CMS to consumers and providers hence the controversy surrounding this rule.

The presentation will provide history, explanation of the rule with both medical and financial outcomes and illustrate with case examples.

Why Should You Attend:

The presentation opens with an explanation and interpretation of the rule and includes exceptions. It explains the reason for the midnight designation based on the use of the midnight census to determine length of stay and provides an example of the calculation.

• A discussion of the goal of the rule and questions about whether it has been achieved
• A description of Medicare Parts A and B payment follows. History is then provided for context - why and how the rule developed including precursors of length of stay reduction and the move from in patient to ambulatory care as well as cast savings objectives.
• Current requirements surrounding the Rule.
• The MOON (Medicare Outpatient Observation Notice)
• MOON components
• Who issues the MOON - implementation options
• How the Rule affects reimbursement or lack thereof for SNF (skilled nursing facility) stays as references in the MOON.
• Role of the Case Manager in the ED.
• Billing issues, Condition 44 code, billing for observation including criteria
• Financial outcomes/implications of the rule for CMS, providers and consumers.
• Example of costs to provider - code requirements for an observation unit in California
• Medical outcomes of the Rule - quality of care, ability to obtain covered continued skilled care Case examples of observation vs inpatient
• Controversy over the bill from cost shifting and consumer rights issues to quality of care concerns to the ability to truly differentiate status.
• Has the bill achieved its goals?
• The purpose of this program is to familiarize the learner with an understanding of the 2 midnight rule as it applies to implementation within a facility including criteria and requirements. The financial outcomes of the rule both intended and unintended will be resented.
• Attendees will be able to explain and interpret the 2 midnight rule
• Will be able to apply criteria to determine patient status
• Will understand and be able to discuss controversy surrounding the rule
• Will be able to discuss the impact of the rule on consumers
• An understanding of the intent and interpretation of the rule will aide the participant in implementing a program to comply with the rule and if implemented can be used to review current practice for compliance. Having a historical context for the rule makes it easier to understand the strategy and anticipate governmental requirements.
• The rule remains controversial with consumers and providers. Implementation of the MOON as well as staff training can mitigate misunderstanding and help to manage consumer expectations surrounding their care and its costs.
• A general understanding of billing issues will be provided but this is not a billing specific program which is a specialized area requiring a separate webinar.

Areas Covered in the Webinar:

• Explanation
• Interpretation
• Historic context
• Patient notification requirement - MOON
• Staffing to accommodate the rule - CM role in the ED, staff training, issuance of above mentioned MOON
• Billing issues
• Financial implications for consumers and providers
• CMS goals/Intent
• Controversy
• Case Examples

Who Will Benefit:

• Case managers
• Social workers
• ED staff
• Patient representatives - those that deal with patient complaints and concerns
• Administrators/managers of compliance, ED, patient financial Services
• Nursing staff for ED and observation units
• Nursing managers, administrators
• Admitting managers
• Insurance navigators