Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 07:37
2-Midnight Benchmark: Discussion of the Hospital Inpatient Admission Order and Certification
2-Midnight Rule

On August 2, 2013, CMS issued a final rule, CMS-1599-F, updating FY 2014 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). The final rule, commonly known as the “2-Midnight Rule,” modifies and clarifies the longstanding policy on Medicare Administrative Contractor review of inpatient hospital and critical access hospital (CAH) admissions for payment purposes. Under this final rule, surgical procedures, diagnostic tests and other treatments (in addition to services designated as inpatient-only), are generally appropriate for inpatient hospital admission and payment under Medicare Part A when the physician expects the beneficiary to require a stay that crosses at least two midnights and admits the beneficiary to the hospital based upon that expectation. This policy responds to both hospital calls for more guidance about when a beneficiary is appropriately treated—and paid by Medicare—as an inpatient and beneficiaries' concerns about increasingly long stays as outpatients due to hospital uncertainties about payment. CMS has released additional clarification (PDF) on the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services.

This MLN Connects™ National Provider Call provides an overview of the inpatient hospital admission and medical review criteria that were released on August 2, 2013. We will address frequently asked questions and answer questions from the public.

Important Disclaimer: Physician certification requirements have been modified to apply in fewer inpatient cases.  Please see the CY 2015 OPPS final rule (79 FR 66997-66999) for more details.

When: Thursday, February 27, 2014

Time:    2:30 PM - 4:00 PM Eastern Time

Target Audience: Hospitals, physicians and non-physician practitioners, case managers, medical and specialty societies, and other healthcare professionals.


  • Order and certification guidance
  • Case examples
  • Transfers
  • Question and answer session

Call Materials:

Slide Presentation (PDF)

Audio Recording (ZIP)

Written Transcript (PDF)

Post Call Transcript Clarification (PDF)

To register for an MLN Connects National Provider Call, please visit the CMS MLN Connects Upcoming Calls registration website.

For More Information:
Additional information on the 2-Midnight Rule can be found on the Inpatient Hospital Reviews web page.