Will the Two Midnight Rule Contribute to backlog in the Medicare Appeals Process?
The question is not really whether the Two Midnight Rule will contribute to the backlog, rather how big the impact will be. CMS regulations rarely simplify the claims process and the Two Midnight Rule won’t be an exception. American Health Lawyers Weekly reported that The American Hospital Association (AHA), along with several other hospitals, filed suit on May 22, 2014 to force The Department of Health and Human Services to adhere to appeals deadlines for reviewing Medicare denials (AHLA Weekly, May 23, 2014). According to the article, the Medicare appeals backlog exceeds 480,000 as of February 12, 2014. This delay is far outside the statutory limits and is creating undue burden for providers, especially small community or rural providers. As it stands, providers are waiting years for payment for services rendered. Once the Two Midnight Rule is fully implemented, the situation will only be compounded. While the purpose of the Two Midnight Rule was to address the increase in the use of observation status and thus decrease the burden on beneficiaries, the rule only complicates the documentation and claims process. CMS has extended the probe and educate period to September 2014, however during this period MACs are conducting post payment audits and denying claims thus contributing substantially to the appeals backlog.
As Chief Compliance Officer, Kesha Boykin-Mclean brings over 20 years of experience in healthcare. Prior to joining VCS, Boykin-Mclean held a number of senior-level compliance roles, including managing and developing the compliance program for St. Francis Hospital in Connecticut. She was also the Division Ethics and Compliance Officer for the Hospital Corporation of America’s Gulf Coast Division where she was responsible for oversight of compliance programs for all hospitals within the division. Most recently, she served as an independent healthcare consultant, assisting hospitals with the planning and implementation of compliance programs.