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2 Midnight Rule

for Inpatient Admissions: Medicare OnlyEffective October 1, 2013, the Centers for Medicare and Medicaid Services (CMS) is implementing a new rule for observation stays and short inpatient stays which requires a signed certification from physicians prior to patient discharge.

How will the 2 Midnight Rule impact Touro physicians?
  • If a physician expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary to the hospital based on that expectation, it is generally appropriate that the hospital receive Inpatient (Medicare Part A) payment.
  • The physician can consider (include) all time a patient has already spent in the hospital as an outpatient receiving observation services, or receiving care in the emergency department, operating room, or other treatment area in guiding their two-midnight expectation.
  • A formal order of inpatient admission is needed to begin inpatient status.
  • Physicians must complete a certification including:
1. The order for admission in the medical record
2. Reasons for the hospitalization
3. The estimated time that the patient will remain in the hospital
4. Plans for the post hospital care

  • Physicians must include in H&P and/or progress notes the following items to support inpatient necessity:
1. Severity of Signs and Symptoms
2. Current medical needs
3. Risk of Adverse events

  • Certification: Certification must be signed and completed prior to of discharge.

Who can write orders/complete certification?
  • Licensed by the State to admit inpatients to hospitals and granted privileges by the hospital to admit inpatients to the facility
  • Knowledgeable about the patient’s hospital course, medical plan, and current medical condition at the time of admission. (Includes the PCP or covering physician; the surgeon or covering; the Emergency or Clinic physician caring for the patient at the time of admission.)
  • The physician or other practitioner needs to be involved in the care of the patient and cannot delegate to somebody who does not fit the above described requirements.

Additional Resources:

For more information contact Louise Bourgeois at ext. 8408.
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Touro Infirmary, 1401 Foucher Street, New Orleans, Louisiana 70115
Phone: 504-897-7011 Pencil
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