backMedicare Advantage (MA) plans are required to provide at least the benefits available under traditional Medicare, yet many increasingly rely on their own criteria to deny or underpay hospital claims that Medicare would cover. The Two Midnight Rule is a prime example: Although CMS has defined when an admission qualifies as “inpatient” for both Medicare and MA plans, many MA plans disregard the rule, resulting in hospitals being underpaid by billions of dollars each year.
Join our panel of managed care litigators to learn practical strategies to challenge payor noncompliance with the Two Midnight Rule. We will cover the legal framework requiring MA plan adherence, the use of InterQual and MCG criteria, Aetna’s new “level of severity inpatient payment policy” and its downstream effects, why regulatory fixes are unlikely, and proactive steps providers can take—through contracting, data collection, and litigation or arbitration—to secure proper payment.