It’s unanimous.  Everybody hates the two-midnight rule—even CMS.

Hospitals hate it.  Doctors hate it.  Congress hates it so much it required CMS to delay audits of compliance until next year.  Then yesterday CMS Deputy Administrator Sean Cavanaugh, testifying before a House Committee panel, acknowledged that CMS is looking for some alternative to the
two-midnight rule.

The two-midnight rule basically says that in order for a hospital to bill for an inpatient stay, the admitting doctor must document a judgment at the time the patient enters the hospital that the patient will need to remain in the hospital through two midnights.  Otherwise, it’s an outpatient visit.  And an outpatient bill may be only a fraction of an inpatient bill.

Sounding a little like Solomon, Cavanaugh testified that Medicare may end up with a rule that “splits the difference” between an inpatient bill and an outpatient bill.