No matter how strong their legal arguments, hospitals will have a tough time convincing judges to overturn Medicare's controversial new rules on classifying inpatients, some legal experts say.
The CMS' so-called “two-midnight” rule was intended to clarify which patients are sick enough to be admitted to the hospital by requiring doctors to certify they have good reason to expect patients to need two nights in the hospital. Only then will Medicare pay inpatient hospital rates for the patients' care.
On Monday, the American Hospital Association and a coalition of members filed two federal lawsuits challenging the rule and its reduction in payments to hospitals. At least three other lawsuits challenging Medicare's inpatient rules are pending. One is a class action filed on behalf of Medicare beneficiaries by the Center for Medicare Advocacy that currently is on appeal.