The OIG has identified vulnerabilities in CMS’ “two-midnight” policy in a report published December 19, 2016. The two-midnight policy mandates that beneficiaries be admitted to the hospital for “two midnights” in order to be considered an inpatient admission and receive Medicare Part A coverage.
In order for beneficiaries to be covered under Medicare for treatment in a skilled nursing facility (SNF), a 3-day inpatient hospital stay prior to SNF admission is required.
In a study conducted by the OIG, the agency found that since the two-midnight policy was implemented in 2014, inpatient stays have decreased and outpatient stays have increased. This has led to beneficiaries in outpatient stays paying more and receiving limited access to SNF care as a result of not meeting the 3-day inpatient requirement to receive Medicare for SNF care.
The OIG recommends that CMS “address these continuing vulnerabilities by improving oversight of hospital billing under the 2-midnight policy and increasing protections for beneficiaries.”