April 16, 2014— The American Hospital Association and several hospital groups and individual hospitals have filed two lawsuits challenging the Centers for Medicare and Medicaid Services’ “two-midnight” rule for deciding whether a patient is an inpatient for Medicare billing purposes. [ms-protect-content id=”2799″]
The two-midnight rule states that hospitals can bill Medicare for procedures, tests, and other treatments on an inpatient basis only when the patient’s stay has spanned two midnights. A hospital patient’s admission status has significant implications for 340B drug discount purposes. Drugs purchased at the 340B-discounted price may be administered or dispensed to outpatients only.
The AHA was joined in the April 14 lawsuits by:
- Greater New York Hospital Association
- Healthcare Association of New York State
- New Jersey Hospital Association
- Hospital & Healthcare Association of Pennsylvania
- Wake Forest University Baptist Medical Center (North Carolina)
- The Mount Sinai Hospital (New York City)
- Banner Health (Arizona)
- Einstein Healthcare Network (Philadelphia).
The lawsuits contend that enforcement of the rule would “burden hospitals with unlawful arbitrary standards and documentation requirements and deprive hospitals of proper Medicare reimbursement for caring for patients,” according to an AHA news release. The lawsuits also contend “that the 0.2 percent cut in payment for 2014 the agency implemented to off-set the increased costs to the Medicare program the agency says are likely to result from the two-midnight rule is arbitrary and should be revoked,” the release stated.
CMS originally planned to begin enforcing the rule on Oct. 1, 2013 but pushed the date back twice, first to March 31 of this year and then to Sept. 30. President Obama signed a bill April 1 that further extended the enforcement moratorium to March 31, 2015. [/ms-protect-content]