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  • 2016 Outpatient Prospective Payment System Clarifies '2 Midnight' Rule—a Little

    In an effort to bring more clarity to the so-called "2 midnight" rule for hospital stay reimbursement, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the 2016 outpatient prospective payment system (OPPS) that acknowledges the importance of clinical judgment and the need for a more collaborative approach in education and enforcement.

    While it doesn't adopt any of the suggestions made by physician groups—for instance, the creation of a "1 midnight" rule—the new rule does make it clear that hospital stays of 2 midnights or more are considered inpatient, while hospital stays under that mark may be payable under Medicare part A based in part on physician judgment.

    Other features of the new rule that are of interest to physical therapists:

    • Payment rate decrease of .3%.
    • Advance care planning. The 2016 rule enables Medicare beneficiaries to discuss advance care planning with their providers.

    APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary of its provisions in the coming weeks.

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