CMS Two Midnight Rule


Instructor: Laura Ostrowsky
Product ID: 705995
Training Level: Intermediate to Advanced

  • Duration: 90 Min
The 2 midnight rule is designed to identify the appropriate level of care for short term stays or episodes in acute care, critical access and long term hospitals and to reimburse accordingly. The rule designed to save money by payment through Medicare part B instead of A is seen by many consumers and providers as both unclear and a cost shift from CMS to consumers and providers hence the controversy surrounding this rule. The presentation will provide history, explanation of the rule with both medical and financial outcomes and illustrate with case examples.
Last Recorded Date: Oct-2019


1 Person Unlimited viewing for 6 month info Recorded Link and Ref. material will be available in My CO Section
(For multiple locations contact Customer Care)

Downloadable file is for usage in one location only. info Downloadable link along with the materials will be emailed within 2 business days
(For multiple locations contact Customer Care)



Customer Care

Fax: +1-650-362-2367

Email: [email protected]

Read Frequently Asked Questions

Why Should You Attend:

The presentation opens with an explanation and interpretation of the rule and includes exceptions. It explains the reason for the midnight designation based on the use of the midnight census to determine length of stay and provides an example of the calculation.

A discussion of the goal of the rule and questions about whether it has been achieved

A description of Medicare Parts A and B payment follows. History is then provided for context – why and how the rule developed including precursors of length of stay reduction and the move from in patient to ambulatory care as well as cast savings objectives.

Current requirements surrounding the Rule.

  • The MOON (Medicare Outpatient Observation Notice)
  • MOON components
  • Who issues the MOON – implementation options
  • How the Rule affects reimbursement or lack thereof for SNF (skilled nursing facility) stays as references in the MOON.

Role of the Case Manager in the ED.

Billing issues, Condition 44 code, billing for observation including criteria

Financial outcomes/implications of the rule for CMS, providers and consumers.

Example of costs to provider – code requirements for an observation unit in California

Medical outcomes of the Rule – quality of care, ability to obtain covered continued skilled care Case examples of observation vs inpatient

Controversy over the bill from cost shifting and consumer rights issues to quality of care concerns to the ability to truly differentiate status. Has the bill achieved its goals?

The purpose of this program is to familiarize the learner with an understanding of the 2 midnight rule as it applies to implementation within a facility including criteria and requirements. The financial outcomes of the rule both intended and unintended will be resented.

Attendees will be able to explain and interpret the 2 midnight rule

  • Will be able to apply criteria to determine patient status
  • Will understand and be able to discuss controversy surrounding the rule
  • Will be able to discuss the impact of the rule on consumers

An understanding of the intent and interpretation of the rule will aide the participant in implementing a program to comply with the rule and if implemented can be used to review current practice for compliance. Having a historical context for the rule makes it easier to understand the strategy and anticipate governmental requirements.

The rule remains controversial with consumers and providers. Implementation of the MOON as well as staff training can mitigate misunderstanding and help to manage consumer expectations surrounding their care and its costs.

A general understanding of billing issues will be provided but this is not a billing specific program which is a specialized area requiring a separate webinar.

Areas Covered in the Webinar:

  • Explanation
  • Interpretation
  • Historic context
  • Patient notification requirement – MOON
  • Staffing to accommodate the rule – CM role in the ED, staff training, issuance of above mentioned MOON
  • Billing issues
  • Financial implications for consumers and providers
  • CMS goals/Intent
  • Controversy
  • Case Examples

Who Will Benefit:

  • Case managers
  • Social workers
  • ED staff
  • Patient representatives – those that deal with patient complaints and concerns
  • Administrators/ managers of compliance, ED, patient financial Services
  • Nursing staff for ED and observation units
  • Nursing managers, administrators
  • Admitting managers
  • Insurance navigators
Instructor Profile:
Laura Ostrowsky

Laura Ostrowsky
President, NYC chapter of CMSA

Laura Ostrowsky RN, CCM MUP is the current president of the NYC chapter of CMSA and a Director on the national CMSA board. She teaches a CCM prep course with the Case Management Institute, works with Athena Forum, and writes andconsults on case management and related topics. Laura has published articles on Case Management in CMSA Today, Professional Case Management, Case in Point, The Patient Flow Journal and other periodicals. She regularly presents at national conferences including CMSA, the Patient Advocate Institute, NTOCC and others on topics ranging from case management, patient flow and payer provider collaboration to advocacy, collaborative practice and case management’s role in the changing health care environment.

Laura is a past Director of Case Management at Memorial Sloan-Kettering Cancer Center (1999-2019) and the 2012 CMSA Case Manager of the Year. Her program was been nominated by Case in Point for excellence in Utilization Management, Discharge Planning and Transitions in Care and awarded the patient Advocate Award. She created a patient advocacy program to assist patients in obtaining access to specialty care despite network restrictions. The program has been featured in articles in Advance for Nursing, The Wall Street Journal, Case in Point, and Case Management Monthly.

Laura holds a master’s degree in Health Planning and Policy from Hunter College.

Laura has 40 years of health care experience, including time as a staff nurse, QA Coordinator, Director of UR and QA, followed by directorships in CM at New York Presbyterian (NYP) and Memorial Sloan Kettering Cancer Center and providing educational presentations as part of the Genentech Speaker’s Bureau.

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Refund Policy

Our refund policy is governed by individual products and services refund policy mentioned against each of offerings. However in absence of specific refund policy of an offering below refund policy will be effective.
Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. ComplianceOnline would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange. Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time. On-Demand Recording purchases will not be refunded as it is available for immediate streaming. However if you are not able to view the webinar or you have any concern about the content of the webinar please contact us at below email or by call mentioning your feedback for resolution of the matter. We respect feedback/opinions of our customers which enables us to improve our products and services. To contact us please email [email protected] call +1-888-717-2436 (Toll Free).




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