Three Day Payment Window Update

The three day payment window was also clarified in the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010”.  The three day payment window policy provides that charges for an inpatient stay include charges for all diagnostic and non-diagnostic services provided on the day of the admission or during three days prior to an inpatient admission (three day payment window) that are related to the inpatient stay.  The law clarifies the term “other services related to the admission” as “all services that are not diagnostic services (other than ambulance and maintenance renal dialysis services) for which payment may be made by” Medicare for services related to the inpatient stay that are provided during the three day payment window.  “If a hospital believes that a non-diagnostic service is truly distinct from and unrelated to the inpatient stay, the hospital may separately bill for the service provided that it has documentation to support that the service is unrelated to the admission, consistent with the new provision.  Such separately billed service may be subject to subsequent review.”  Hospitals should put procedures in place to ensure all relevant services are included in the admission as applicable and not separately billed.  To view the law, go to: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962enr.txt.pdf
Or to view the CMS announcement, go to: http://www.cms.gov/FFSProvPartProg/EmailArchive/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=CMS1236727&intNumPerPage=2000

Tagged as: Three Day Payment Window