New Comprehensive Report Provides Answers to Questions Raised by CMS’ Two-Midnight Rule

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The latest report in Atlantic Information Services’s Management Insight Series, The Two-Midnight Rule: Practical Strategies for Hospital Compliance Officers, provides answers to questions hospitals have about complying with CMS’s two-midnight rule.

The two-midnight rule — the Centers for Medicare & Medicaid Services’ (CMS) effort to provide guidance on when a hospital admission is medically necessary for Medicare claims purposes — challenges hospitals to change their thinking, their training and their decision making about when to admit a patient to their facility. Even with a grace period before real enforcement begins this October, the rule — and the physician order and certification requirements accompanying it — continues to raise complex questions from hospitals and responses from CMS. Now available from Atlantic Information Services, Inc. (AIS) – the publisher of industry-leading newsletter Report on Medicare Compliance – is The Two-Midnight Rule: Practical Strategies for Hospital Compliance Officers, which provides answers to questions such as:

  • What is the difference between the two-midnight “presumption” and the two-midnight “benchmark”?
  • When does “time” begin for purposes of the two midnights? What factors influence this determination (e.g., what if the patient is transferred to the facility)?
  • What information is needed on patients in intensive care units?
  • What exactly does the admitting order need to say?
  • Who can sign an order, who can sign a certification, and when? What about advance practice nurses or residents?
  • What role will commercial criteria play in two-midnight decision making?
  • What claims can the RACs and MACs review between Oct. 1, 2013, and Oct. 1, 2014?
  • What recourse does a hospital have if a two-midnight claim is denied?
  • How does a hospital work with condition code 44 under the two-midnight rule?

The report is the latest in AIS’s Management Insight Series, adapted from a September 2013 AIS webinar presented by Abby Pendleton and Jessica L. Gustafson, founding partners with the health care law firm of The Health Law Partners, P.C. It has been updated and edited by Frances Fernald, Managing Editor at AIS.

Additionally, The Two-Midnight Rule: Practical Strategies for Hospital Compliance Officers also provides all of the official documents released on the two-midnight rule — the regulatory language, the preamble to the final rule and all guidance CMS has issued on it. Citations in the text make it easy to locate what CMS says on a particular point.

For more information on The Two-Midnight Rule: Practical Strategies for Hospital Compliance Officers, including a full table of contents, visit

AIS’s Management Insight Series is designed to provide practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers. See a full list of titles in this series at

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
Atlantic Information Services
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