CMS Extends Enforcement Delay of Hospital Short-Stay Rule

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By Michael D. Williamson

Aug. 12 — In a move praised by the hospital industry, the CMS said Aug. 12 it won't allow Recovery Auditor Contractors to conduct patient status reviews of short-term hospital admissions through the end of 2015.

Rick Pollack, the executive vice president of the American Hospital Association, praised the short-term patient status reviews announcement in an Aug. 12 statement.

The AHA is pleased that the Centers for Medicare & Medicaid Services has extended the partial enforcement delay of the two-midnight policy through the end of the year, which would continue to prevent RACs “from issuing inappropriate denials for medically necessary patient care,” Pollack said.

The enforcement delay had been set to expire Sept. 30.

Under the current policy, which the CMS first adopted in 2013, Medicare doesn't fully reimburse hospitals for stays not expected to span at least two midnights. The agency currently prohibits auditors from conducting admission status reviews for claims that would be subject to the two-midnight rule if the hospital has been paid.

With the Aug. 12 announcement from the CMS, that prohibition will extend to the end of the year.

The CMS also recently announced proposed changes to the two-midnight rule itself. Under changes in a July proposed rule, certain stays for which a physician expects a patient to need less than two midnights of hospital care would be payable under Medicare Part A on a case-by-case basis.

Comments on that proposed rule (80 Fed. Reg. 39,200; CMS–1633–P) are due Aug. 31.

To contact the reporter on this story: Michael D. Williamson in Washington at

To contact the editor responsible for this story: Janey Cohen at

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