Understanding the Finer Points of the Two-Midnight Rule

Published: Thu, 10/31/24

Updated: Mon, 11/04/24

Link to all things medical coding & billing

Understanding the Finer Points of the Two-Midnight Rule

Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few regulations are easier to explain. For both patients with traditional Medicare and those who elected to be in a Medicare Advantage (MA) plan, if two things are true, the patient should be admitted as an inpatient.

CMS OPPS Proposed Rule: Considerations for Social Drivers in Outpatient Settings

If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants of health (SDoH) in the outpatient settings, specifically Hospital Outpatient Departments (HOPDs), Rural Emergency Hospitals (REHs), and Ambulatory Surgical Centers (ASCs).

HIPAA Changes Providers Need to Heed

Here are some important HIPAA reminders and updates. First, on the Security Rule side of things: this past Thursday, the U.S. Department of Health and Human Services Office for Civil Rights posted its latest settlement with a covered entity related to alleged HIPAA violations. This $250,000 settlement, with a Washington-based healthcare provider...

2025 ICD-10-CM Codes Are Now in Effect: Key Updates You Need to Know

The 2025 updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) are now in effect, running from October 1, 2024, through September 30, 2025. While perhaps not as eagerly awaited as a Taylor Swift album drop, these changes are essential for healthcare professionals and providers to understand.

Interoperability in healthcare moving forward despite challenges

Interoperability has been a longstanding goal for healthcare: The promise of being able to exchange data seamlessly between health information networks has been a goal the industry has been working toward for years, and now payers and healthcare organizations have to wrangle with rules, passed by the Centers for Medicare and Medicaid Services...

Are CDI Programs Operating at the Top of Their Game?

The clinical documentation integrity (CDI) profession began its heyday in 2008, with the advent of the Medicare Severity Diagnosis-Related Group (MS-DRG) system that built and expanded upon the simpler system consisting of DRGs with complications and comorbidities (CCs) or major CCs (MCCs) and those without.

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