CMS proposes to eliminate requirement for written inpatient admission orders

On April 24, 2018, the Centers for Medicare and Medicaid Services (CMS) published the 2019 Medicare Inpatient Prospective Payment System proposed rule (2019 Proposed IPPS Rule), which contains a number of proposals designed to reduce administrative burden on Medicare providers. One such proposal would eliminate the requirement that a written inpatient admission order must be present in the medical record as a condition of payment under Medicare Part A.

In the 2014 IPPS final rule, CMS adopted the “Two-Midnight” rule that sets forth the Medicare rule for when a Medicare beneficiary is appropriately admitted to a hospital as an inpatient. As part of that 2014 rulemaking, CMS codified at 42 CR 412.3 its “longstanding policy” that a written inpatient admission order must be present in the medical record as a specific condition of Medicare Part A payment.

Now, in the spirit of reducing unnecessary administrative burden, CMS is proposing to remove the requirement, because “some otherwise medically necessary inpatient admissions are being denied payment due to technical discrepancies [such as missing practitioner admission signatures, missing co-signatures or authentication signatures, and signatures occurring after discharge] with the documentation of inpatient admission orders.” In proposing the elimination of the written inpatient admission order requirement, CMS noted that “[i]t was not our intent when we finalized the admission order documentation requirements that they should by themselves lead to the denial of payment for [an] otherwise medically reasonable [and] necessary inpatient stay.”

According to CMS, as long as other available documentation supports that all coverage criteria are met and the hospital is operating in accordance with the hospital conditions of participation, “it is no longer necessary to also require specific documentation requirements of inpatient admission orders as a condition of Medicare Part A payment.”

The deadline for submitting comments on the 2019 Proposed IPPS Rule is June 25, 2018.