The 2-midnight presumption directs medical reviewers to select Part A claims for review under a presumption that the occurrence of 2 midnights after formal inpatient hospital admission pursuant to a physician order indicates an appropriate inpatient status for a reasonable and necessary Part A claim. The full text is quoted here : http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/QAsforWebsitePosting_110413-v2-CLEAN.pdf I think the issue here is that the inpatient measures will consider an encounter to be inpatient if it does not align with the 2 midnights rule. Based on our understanding of reading the below paragraph, CMS would not consider those encounters to be valid inpatient encounters. Therefore, for MU reporting they are valid inpatient encounters, but for claims they are not. I believe that’s the problem here. Our guess would be that the measures may need to add an appropriate lower bound on length of stay to verify that they are appropriate inpatient encounters if MU should align with the CMS 2 midnights rule. There may be need to be a policy decision as to whether MU needs to align with the 2 midnights rule.

We noticed that there were outpatient encounters that were falling into our STK Meaningful Use CQMs/emeasures. When we asked epic how the 2 Midnight rule and Hospital Outpatient Visits (HOVs) would effect the CQMs we received the following response: "The CMS 2 Midnight rule is completely independent of Meaningful Use and does not affect what is considered inpatient for CQMs. MU & CMS do not and are not intended to overlap so while these patients don't meet Inpatient for the CMS 2 midnight rule, they are still considered for MU CQM standards. Is this correct? How can we submit these emeasures and how are they valid if they do not utilize the Inpatient population?