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CMS has created a giant loophole that continues to perplex. I get a lot of questions about status changes. To explain how even the seemingly simple questions are not always so easy, I want you to picture a patient. She is 75 years old and has a cough. She is…
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Treating a heart attack as outpatient may sound ludicrous, but for some hospitals it may be the right choice. The two-midnight rule threw the hospital utilization review community into turmoil when it was implemented on Oct. 1, 2013. In brief, that rule mandates that the decision of whether to enact…
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I have written a lot in the past about the two-midnight rule exception for physician judgment of the need for inpatient admission with an expectation of a stay of under two midnights. As a reminder, when the two-midnight rule was first adopted, the only approved exceptions to the two-midnight expectation…
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As I discussed in my RACmonitor article published last week, the Centers for Medicare & Medicaid Services (CMS) has left the mechanics of the two-midnight rule intact in its proposed Inpatient Prospective Payment System (IPPS) rule for 2018. That means that for at least another year, we will have to…
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Since it was put into place back in 2013, most of us have managed to grasp the specifics of the Medicare two-midnight rule. Whether there was an anticipation of two midnights of medically necessary care in the hospital at the time of admission, or expectation of a second, medically necessary…
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