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Hospitals can provide services on either an inpatient or an outpatient basis

Hospitals can provide services on either an inpatient or an outpatient basis

What’s the issue?

Medicare pays for inpatient services and outpatient services under separate and very different payment systems, which can produce substantially different payment amounts for similar patients receiving similar services. The cost-sharing implications for beneficiaries under the two systems can also vary significantly.

Until recently, the Centers for Medicare and Medicaid Services (CMS) had provided little guidance to hospitals on how to determine whether a particular patient should be treated on an inpatient or outpatient basis. In the absence of guidance–and in response to other CMS efforts to ensure proper payments, including creation of the Recovery Audit Program–hospitals’ shifting of services between inpatient and outpatient settings has had significant implications for the beneficiaries receiving such services and for the Medicare program as a whole.

In 2013 CMS announced the so-called two-midnight rule to clarify when it expected a patient to be designated to inpatient status. chicas escort Lakewood Under this rule, only patients that the doctor expects will need to spend two nights in the hospital would be considered as hospital inpatients.

This brief describes the perceived need by CMS for the two-midnight rule, how it would work, and the implications for Medicare payment. ايدين هازارد تشيلسي

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