With the 2024 Proposed Rules impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D, one thing is clear: the various aspects of the Two-Midnight Rule are firmly in place for short-stay admissions.

In a significant development for 2024, the Two-Midnight Rule now extends to Medicare Advantage patients (Medicare Parts C & D). While admitting providers often find traditional Medicare and Medicare Advantage patients indistinguishable, administrative grouping and processing differences can affect patient case management. Case Managers, Utilization Review teams, and hospital staff must now distinguish between these groups to ensure compliance with the Two-Midnight Rule.

Moreover, a crucial difference between traditional Medicare and Medicare Advantage patients directly impacts post-discharge medical reviews and compliance risk. As traditional Medicare short-stay admits potentially meeting Two-Midnight Rule criteria face renewed Quality Improvement Organization (QIO) audits, understanding compliance nuances is paramount.

Why This Is Relevant:

This webcast, led by esteemed expert, Michael G. Calahan, PA, MBA, Certified Compliance Officer, Certified Clinical Documentation Integrity, Certified Forensic Healthcare Auditor, offers a comprehensive exploration of Two-Midnight Rule essentials. He’ll delve into the implications for Medicare Advantage patients, providing a clear roadmap for navigating the evolving landscape to help you ensure your facility is well-equipped to handle federal and Medicare Advantage audits effectively. Gain insights into patient access points, personnel roles, and compliance requirements, ultimately enhancing your hospital’s operational efficiency and risk mitigation strategies.

Learning Objectives:

• Two-Midnight Rule: Understand CMS guidelines, vulnerabilities, and compliance points for inpatient and outpatient admissions.
• Medicare Advantage Impact: Differentiate between Medicare plans, grasp how the Two-Midnight Rule affects Medicare Advantage patients, and ensure adherence.
• Outpatient Observation: Discover crucial outpatient observation compliance points to enhance short-stay admissions.
• Inpatient-Only List: Assess 2024 updates to the CMS Inpatient-only list and its implications for short-stay admissions and observation care.
• Hospital Admit Orders: Learn the requisites and key considerations for short-stay inpatient admissions and outpatient observation care.
• Workflow and Protocols: Implement best practices to manage risk through cross-departmental protocols and effective workflows.

Who Should Attend:

Case Managers, QA/UR Staff, UR Committee Members, In-house & External Physician Advisors