- CMS announced its final 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule and comment period Friday.
- The rule finalizes CMS's controversial two-midnight policy for hospital stays to be billed as admissions rather than observation stays.
- The rule also allows physicians to utilize judgment to admit patients for shorter durations, but does not provide explicit guidance on when they may do so.
Critics of the 2016 OPPS rule have voiced concern and surprise CMS did not accept any counterproposals to the two-midnight policy, such as creating a one-midnight rule, or provide more detail on the "physician judgment" exception to the rule.
CMS has disagreed such actions were necessary and addressed concerns about potential gaming of the hospital admissions process. Among other changes, it notes recovery audit contractors (RACs) will no longer be utilized as first reviewers for short patient claims.
Groups including the American Hospital Association released statements about the rules.
"Hospitals appreciate the certainty that stays of at least two midnights are inpatient, with stays of less than two midnights also considered inpatient based on physician judgment," Thomas Nickels, executive vice president of government relations and public policy for the AHA, said in a prepared statement.