House ‘Doc-Fix’ Bill Would Extend Two-Midnight Enforcement Delay

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Buried in a House of Representatives bill to delay Medicare payment cuts for physicians or craft a new payment formula is not only language to delay the ICD-10 compliance date to October 2015, but to further delay enforcement of the “two-midnight” payment rule for certain hospital stays.

Under the two-midnight rule, Medicare will not reimburse hospitals under Part A for inpatient-level services provided to Medicare beneficiaries for treatment that does not span two midnights. The Centers for Medicare and Medicaid Services considers such treatment to be outpatient and payable under Part B.

The rule was effective in October 2014 but provider organizations strongly objected, arguing the policy undermines medical judgment and safe care practices, does not give adequate time to revamp software systems and policies and procedures, and financially hurts providers.

CMS has twice postponed enforcement of the rule, first through March 31, 2014, and then through Sept. 30, 2014. Now, language in H.R. 4302, titled “The Protecting Access to Medicare Act,” would prohibit Medicare Recovery Audit Contractors from auditing claims under the two-midnight rule for another six months, through March 31, 2015.

The American Coalition for Healthcare Claims Integrity, representing RACs and other government contractors, is not pleased with the proposed longer moratorium on RACs auditing these types of claims. “Ultimately, this sets a dangerous precedent that in order to get buy-in from hospitals on changes to Medicare policy, Congress must first absolve them from all Medicare oversight,” the group contended in a statement issued on March 27. “By this logic, hospitals will never be held accountable for the billions they over-bill to Medicare every year, and taxpayers and beneficiaries will be forced to shoulder the additional burden of waste in the healthcare system.”

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