News & Insights


CMS’s 2016 OPPS Proposed Rule: Changes to the Two Midnight Rule and Patient Status Reviews

On July 1, 2015, CMS issued the Calendar Year 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule, which includes proposed changes to the controversial Two Midnight Rule. In response to stakeholder concerns, CMS seeks to significantly expand a current exception to the Two Midnight rule. However, CMS’s proposal raises serious questions regarding the practical implications of the potential rule change.

In addition, CMS announced changes regarding the review of patient status claims. No later than October 1, 2015, CMS intends to have Quality Improvement Organization (QIO) contractors conduct reviews of short inpatient stays rather than the Medicare Administrative Contractors. Those hospitals that are found to have high denial rates will be referred to Recovery Audit Contractors (RACs) for further audits.

On Tuesday, July 14, 2015, King & Spalding will host a Roundtable to discuss the details of the OPPS Proposed Rule, as well as practical considerations for providers. The in-person Roundtable will take place in King & Spalding’s Atlanta office, and there will be a live webinar registration option as well.

We are also offering a Webinar option for the Roundtable.

Topics discussed during the Roundtable will include:

  • Is the proposed change to the Two Midnight Rule beneficial for providers?

  • What are the practical implications of the proposed changes?

  • What are the implications of QIO patient status audits? What role will RACs have?

Speakers will include Sara Kay Wheeler and Lauren Gennett from our Atlanta office and Mark Polston from our Washington, D.C. office.

You do not have to be a client to attend, and there is no charge.

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If you have questions concerning this Roundtable Webinar, e-mail

Event Details

Date: July 14, 2015

Time: 8:00 pm