Two- Midnight Rule

Jennifer Turner

Networker
Local Chapter Officer
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41
Location
Indianapolis, IN
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Hello Fellow Coders!

I am needing any input on this one. Does this rule apply only to pt.'s who have traditional Medicare as the primary payor? I have exhausted all resources at this point & All of the information that I have researched shows strong evidence that this rule only applies to traditional Medicare pt.'s....... Between 3 coders within our practice there is really no clarity, a lot of back and forth.

Any help is very much appreciated. Thank you so much!!
 
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The two-midnight only applies to traditional Medicare beneficiaries (A/B patients), although Medicare Advantage programs (Part C) may choose to follow this rule, usually based upon a contract with the hospital. This is the biggest reason that the two-midnight rule has not simplified things for hospitals or physicians since each payer may or may not follow this guidance.
 
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