Articles and Blogs

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. However, CMS also stated that care spanning two midnights is not “presumed” appropriate for an inpatient level of care under... READ MORE

The Office of Inspector General (“OIG”) in its November Work Plan has put hospitals on notice that it is going to begin auditing short-stay inpatient claims for compliance with CMS’s Two-Midnight Rule. Short stay claims – claims for inpatient stays of less than two midnights – have caused hospitals and providers considerable confusion over... READ MORE