What is the CMS rule that requires an inpatient stay to cross two midnights for Medicare Part A payment?

The Medicare Two-midnight rule is a crucial guideline established by the Centers for Medicare & Medicaid Services (CMS) that helps determine inpatient hospital admissions and eligibility for Part A payments. Under this rule, an inpatient stay must span at least two midnights in order for the stay to be billed as inpatient services and qualify for Medicare Part A reimbursement.

The rationale behind this rule is that it establishes a clear benchmark for hospital admissions, making it easier to delineate between inpatient and outpatient statuses. Specifically, when a physician admits a patient and anticipates that the patient will require hospital care for two midnights or more, the admission can generally be classified as an inpatient stay, justifying Medicare's payment eligibility under Part A.

This rule also helps streamline the admission process for patients and providers alike, ensuring that patients are receiving the appropriate level of care based on their medical needs while also complying with Medicare regulations. This is vital for hospitals as it influences their revenue cycle and the financial aspects of patient care.