2-Midnight Rule and MA plans

CodeCast | Medical Billing and Coding Insights

When a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary as an inpatient or treat him or her as an outpatient.

These decisions have significant implications for hospital payment and beneficiary cost sharing. Not all care provided in a hospital setting is appropriate for inpatient, Part A payment.

Terry discusses the 2-midnight rule, and how that impacts both Part A and Part B providers and patients. There is more to consider than meets the eye.

Terry also covers what CMS recently published in the Final Rule for MA plans.

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