CMS monitors the frequency of beneficiaries being treated as hospital outpatients (e.g., being treated in observation units, which is paid under Medicare Part B). CMS adopted the Two-Midnight rule for admissions beginning on or after October 1, 2013. This rule established Medicare payment policy regarding the benchmark criteria that should be used when determining whether inpatient admission is reasonable and payable under Medicare Part A. In general, the Two-Midnight rule stated that Inpatient admissions will generally be payable under Part A if the admitting practitioner expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation.
This field comes from the Claim Occurrence Span Code = 72 that is present on any claim included in the stay. If an occurrence span code = 72 is found, set the indicator to 'Y'. If no occurrence span code of 72 is found on any of the claims set the indicator to 'N'.
Source: NCH
Code
Code value
Y
Yes, the beneficiary received outpatient services within the hospital, prior to admission
N
No outpatient services immediately prior to admission
CMS monitors the frequency of beneficiaries being treated as hospital outpatients (e.g., being treated in observation units, which is paid under Medicare Part B). CMS adopted the Two-Midnight rule for admissions beginning on or after October 1, 2013. This rule established Medicare payment policy regarding the benchmark criteria that should be used when determining whether inpatient admission is reasonable and payable under Medicare Part A. In general, the Two-Midnight rule stated that Inpatient admissions will generally be payable under Part A if the admitting practitioner expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation.
This field comes from the Claim Occurrence Span Code = 72 that is present on any claim included in the stay. If an occurrence span code = 72 is found, set the indicator to 'Y'. If no occurrence span code of 72 is found on any of the claims set the indicator to 'N'.
Source: NCH