2024 The Two Midnight Rule and Medical Necessity in the Hospital Setting (34) – Post Test

1. A patient is admitted for a procedure that is on the “inpatient only” list. They would be admitted as an inpatient

2. Regarding Medicare Fee for Service (not Medicare Advantage), which is TRUE?

3. The Two Midnight Rule

4. Which of the exclusions listed below apply to the Two Midnight Rule “exception”:

5. You have a longstanding Medicare patient (not Medicare Advantage) come in with COPD exacerbation. He is not on oxygen at home, and his sats were 77% on RA and did not stabilize until he was placed on BiPAP.  But, this presentation is as before, and he usually stays 4-5 days before stabilizing enough to return home (and most of these hospitalizations requiring BiPAP). He refuses mechanical ventilation and has this noted on his chart.  You expect this admission to be as previous and to stay more than two midnights, so you ordered for inpatient care on admission.  The patient responded more quickly than expected and on the evening rounds of day two, asked to go home.  He is actually on room air, ambulates with stable vitals, and amazingly seems back to baseline.  His family came in to town it is this morning and are here to visit him. They agree to watch over him and to get him into his PCP tomorrow morning or call back tonight if he worsens.  Clinically, you agree with his request, and you feel good about the discharge plan. Because the patient did not pass two midnights, you should

6. A surgical procedure was admitted electively as “inpatient” for a procedure that is on the “Inpatient Only” list. After the procedure, the Attending Surgeon states she disagrees with that determination because the procedure was “not that hard” and the patient will be going home first of next morning, before the second midnight. You have knowledge of inpatient and observation status determination, so you offer to help her work through this process.  You recommend for her to

7. Some Medicare medical admissions (CHF, aspiration pneumonia, Acute MI, etc.) have a specific Medical Inpatient Only (MIO) list that gets updated each year by CMS.

8. The CMS Medicare Advantage (MA) Final Rule in 2023 was released partly because

9. On day two (“D-day”) of a hospital stay where the patient was admitted as OBSERVATION, what would help secure the medical necessity of inpatient status (and thus requiring an INPATIENT order)?

10. Which of the following COPD scenarios would most likely merit INPATIENT hospitalization from initial presentation (and assumption of active management beyond 2MN)?