Medicare Patients Caught In Two-Midnight Rule Crossfire


Hospitals have been complaining about the two-midnight rule since it was first announced.  But mounting evidence indicates that Medicare patients themselves are suffering badly from the effects of the rule.

The rule basically says that in order for a hospital to bill Medicare 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 or longer.  Otherwise, it’s not a qualifying inpatient stay, and the hospital’s payment from Medicare may be only a fraction of the payment for an inpatient stay.

So it’s easy to see why hospitals are upset by the rule.  Their unhappiness has been widely documented.  But what about the patients?  It turns out that they have a real financial stake in the controversy.  That’s because a patient’s share of the hospital bill is typically much greater when a hospital visit doesn’t result in admission as an inpatient.  So the patient, who may have spent the night in the hospital and in all likelihood thought he was an inpatient, is in for a rude awakening when he eventually receives the hospital bill.

And the patients are not just victims: they’re innocent victims.  The rule was enacted to correct what Medicare saw as lax admitting standards on the part of hospitals.   No one—not even Medicare—complained that patients were too eager to check into hospitals as inpatients.

But help may be in sight.  A CMS Deputy Administrator testified in late May that CMS is looking for some alternative to the rule.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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