The CMS’ Two-Midnight Rule and Medical Necessity

Activity description

Understanding and applying the concept of medical necessity and the Centers for Medicare & Medicaid Services’ (CMS’) Two-Midnight Rule are paramount to ensuring both compliance and high-quality care for patients who are admitted to the hospital. This activity, which includes interactive case studies, will examine the factors that impact medical necessity and the types of reviews that can be applied. It will provide participants with an improved ability to navigate these regulations and practical insight into effectively integrating these standards into their daily practice. 

Provided by
This activity is provided by Optum Health Education and Optum Advisory Services.

Commercial support
No commercial support was received for this activity.

Required hardware/software
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Target Audience

This activity is designed to meet the educational needs of case managers, nurses, social workers and other HCPs who have an interest in learning to understand and apply the concept of medical necessity and the Centers for Medicare & Medicaid Services’ (CMS’) Two-Midnight Rule

Learning Objectives

At the end of this activity, participants should be able to:

  • Discuss how to accurately apply the concept of medical necessity and the Two-Midnight Rule to patient presentations.
  • Describe available resources that can be leveraged to assist in determining medical necessity.
  • Identify the importance of utilization review standards and how they impact quality of care.
Activity summary
Available credit: 
  • 1.00 ANCC - Nurses
  • 1.00 Attendance - General Attendance
  • 1.00 CCMC - General - Case Managers
  • 1.00 ASWB - Social Workers
Activity opens: 
04/22/2024
Activity expires: 
04/22/2027
Rating: 
5

Activity planners
Elizabeth Albert, MD
Clinical Activity Manager
Optum Health Education

Lacy Johnson, MSN, RN, CNL, PHN
Senior Consultant - Education
Optum Advisory Services
Provider Clinical Practice

Keith Jones DNP, MSN, RN, CEN 
Education Manager, Optum Advisory Services
Provider Clinical Practice

Briana Sam, MS 
Senior Consultant, Instructional Designer
Optum Advisory Services
Provider Clinical Practice

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty and planners have no financial relationships to disclose.

 

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation statement
Joint Provider LogoIn support of improving patient care, this activity has been planned and implemented by Optum Health Education and Optum Advisory Services. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit designation statements

Case managers
The Commission for Case Manager Certification has approved this program for a maximum of 1.00 clock hours for Certified Case Managers (CCM).

Nurses
The participant will be awarded up to 1.00 contact hour(s) of credit for attendance and completion of supplemental materials.

Social workers
ACE LogoAs a Jointly Accredited Organization, Optum Health Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Optum Health Education maintains responsibility for this course. Social workers completing this course receive 1.00 enduring continuing education credits.

Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.

Available Credit

  • 1.00 ANCC - Nurses
  • 1.00 Attendance - General Attendance
  • 1.00 CCMC - General - Case Managers
  • 1.00 ASWB - Social Workers
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