Group Advising Congress Seeks End Of Medicare’s ‘Two-Midnight’ Rule
The Medicare Payment Advisory Commission, or MedPAC, is looking at ways to get rid of Medicare's "two-midnight" rule by eliminating the category of observation status at hospitals. Meanwhile, patient groups join regulators in advocating for greater federal oversight of certain diagnostic tests.
MedPAC Attempts To Eliminate Two-Midnight Rule
The Medicare Payment Advisory Commission is mulling trying to solve the conundrum posed by the widely panned “two-midnight rule” by eliminating the outpatient observation claims that gave rise to it. The CMS hatched the two-midnight rule so hospitals would stop billing patient stays under observation codes to insulate their claims from the government's audit contractors. As a result, though, Medicare beneficiaries were hit with the higher out-of-pocket costs of Medicare Part B and couldn't get reimbursement for skilled nursing after leaving the hospital. Under the two-midnight rule, an admission is presumed to be appropriate if the patient's stay crosses two midnights. Providers, however, argue that rule undermines their clinical judgment and has created more confusion than clarity. Congress this year delayed the enforcement of the policy, and the CMS has solicited ideas to improve it. (Dickson, 11/18)
More Oversight Urged For Laboratory Developed Tests
Patient groups joined the Food and Drug Administration and Centers for Medicare and Medicaid Services on Tuesday to advocate for greater federal oversight of certain diagnostic and genetic tests. The FDA released draft guidance last month – with final rules coming in February after a 120-day public comment period – for enhanced regulations of laboratory developed tests, or LDTs, which are designed, manufactured and used in-house. LDTs are not required to go through the FDA’s typical premarket review and approval process, partly because the tests were historically simple and limited. Instead, CMS is responsible for oversight of the tests, which patient groups said was more limited. They likened the agency’s role to that of a health inspector determining whether a restaurant passes inspection. (Zanona, 11/18)