The new CMS “Two-Midnight Rule,” which is intended to provide greater clarity regarding when inpatient hospital admissions are generally appropriate for Medicare Part A payment, goes into effect today.
The new CMS “Two-Midnight Rule,” which is intended to provide greater clarity regarding when inpatient hospital admissions are generally appropriate for Medicare Part A payment, goes into effect today. However, in order to address widespread concern among hospitals and doctors about the new rule, CMS officials announced last Thursday that government recovery auditors will delay scrutiny of short inpatient stays for 90 days while providers get acclimated to the new policy.
Last month, the Department of Justice (DOJ) announced that it had entered into a $25.5 million settlement with Intermountain Health Care, Inc. (Intermountain), Utah’s largest health system with 22 hospitals and more than 4,500 physicians, to resolve self-reported violations of the Stark Law and the False Claims Act.
Section 501(r) was added to the Internal Revenue Code by the Patient Protection and Affordable Care Act in order to expand and clarify the federal requirements for tax-exempt hospitals by establishing new standards relating to community health needs assessments; financial assistance policies; and hospital charges, billing, and collection practices.
During the course of an integration negotiation, both hospital executives and physicians focus much of their attention on financial matters, and perhaps rightfully so. However, a strong governance model may be the key to the long-term success of the relationship. Many integrated physicians will often point to governance, and not compensation, as the reason why their arrangement ultimately succeeded or failed. Not surprisingly, most physicians are concerned that they will lose practice autonomy following an integration, so certain aspects of practice op