Every short-stay inpatient admission carries financial and compliance risk.
More than a decade after implementation, the Two-Midnight Rule remains one of the most heavily scrutinized Medicare payment policies. Federal auditors, Medicare Administrative Contractors (MACs), the Office of Inspector General (OIG), and Medicare Advantage plans continue to closely review short-stay inpatient admissions, while evolving CMS guidance has made compliance even more challenging. Add AI-driven claim analytics, changing inpatient-only procedure policies, and increasing Medicare Advantage oversight, and even well-established admission practices can expose hospitals to denials, repayments, and costly audit findings.

This practical RACmonitor webcast will help you confidently navigate today's evolving regulatory landscape. Compliance expert Michael Calahan will explain the latest 2025-2026 Two-Midnight Rule policy changes, clarify how they affect admission decisions, physician documentation, observation services, inpatient-only procedures, and admission orders, and provide practical best practices that can be implemented immediately. You'll leave with a stronger understanding of where your organization's greatest vulnerabilities exist, and how to reduce them before they become audit targets.

Why This is Relevant:

There has never been a more important time to revisit your Two-Midnight Rule strategy. CMS policy changes implemented in 2025 continue to reshape medical review in 2026, while the proposed 2027 OPPS Rule signals significant additional changes affecting short-stay admissions for inpatient-only procedures. At the same time, AI-powered audits, increased Medicare Advantage enforcement, and continued federal scrutiny mean hospitals can no longer rely on outdated processes. Preparing now can help protect reimbursement, strengthen compliance, and position your organization for what's coming next.

Learning Objectives:

• Understand the latest 2025 and 2026 Two-Midnight Rule policy and program changes.
• Prepare for the potential impact of the proposed 2027 OPPS Rule on short-stay admissions involving inpatient-only procedures.
• Identify the most common compliance risks that lead to denials, repayments, and audit findings.
• Evaluate how changes to the CMS Inpatient-Only List affect admission decisions.
• Better manage admission "gateways" across emergency departments, surgery, hospitalists, case management, and utilization review.
• Recognize how Medicare Advantage requirements intersect with the Two-Midnight Rule.
• Implement practical workflows and cross-departmental strategies that improve compliance while reducing organizational risk.

Who Should Attend:

• C-Suite Executives (hospitals, health systems & networks: CFO, CEO, COO)
• Health System Legal Teams (Compliance Counsel, Attorney, Associate Attorney)
• Compliance Officers & Auditing Teams (Compliance Auditing Specialists)
• Corporate Responsibility Officers (Compliance)
• Case Managers (Emergency Room, PACU, Inpatient, Outpatient Observation)
• Revenue Cycle Services (1-V.P., 2-Director, 3-Manager)
• Patient Financial Services (V.P., Director)
• Patient Billing Manager
• Patient Registration Director
• Hospitalist Teams and Practices
• Emergency Department Physicians & Providers
• Surgical Specialty Physicians (who perform inpatient-only and outpatient surgical procedures)
• Case Managers (Inpatient, Outpatient Observation)
• Quality Assurance (QA) Staff
• Utilization Review (UR) Staff
• Utilization Review (UR) Committee Members incl Chairman, Physicians, Nurses
• Operating Room (OR) Inpatient Director, Manager, Inpatient Liaison
• Same Day Surgery (SDS) Director/Manager
• Post-Anesthesia Care Unit (PACU) Director, Manager, Inpatient Liaison
• HIM Department (V.P., Director, Manager, Assistant Director, Assistant Manager)
• Clinical Documentation Improvement (CDI) Specialists
• Recovery Audit (RA) and Recovery Audit Contractor (RAC) Audit Team Coordinators
• Quality Improvement Org (QIO) Audit Team Coordinator
• Medicare Advantage Registration & Preauthorization Staff