Q&A: 2-midnight rule during COVID-19 pandemic

Q: How has the 2-midnight rule been impacted by waivers issued during the novel coronavirus (COVID-19) pandemic? What changes should case managers be aware of?

A: While 1135 waivers have been used by CMS to suspend certain payment rules and regulations during the public health emergency, the 2-midnight rule remains intact. For inpatient admission, the physician must reasonably expect that the patient will need at least two midnights of care. Hospital case managers still need to be certain that patients are assigned the correct status when they are brought into the hospital.

There has been one change, however. If a patient is incorrectly admitted as an inpatient, he or she can be changed back to an outpatient without a review by a utilization review committee, says Ronald Hirsch, MD, FACP, CHCQM, vice president at R1 Physician Advisory Services in Chicago.

Editor's note: This topic was originally covered in the June issue of Case Management Monthly.