Note from Hugh
Medicare Insider, August 12, 2008
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It is clear that diagnostic services and related therapeutic services furnished by a hospital-owned medical practice during the three-day window are subject to the three-day payment window (and therefore may not be separately billed as outpatient services) if the medical practice is treated as “provider-based” for Medicare purposes.
Policy: A hospital-owned or hospital operated physician clinic or practice is subject to the payment window provision. The technical portion of preadmission diagnostic services performed by the physician clinic or practice must be included in the inpatient bill and may not be billed separately. A physician’s professional service is not subject to the window.
63 Federal Register 6866 (February 11, 1998)
If my reading of CMS comments is correct, a hospital may not bill separately for diagnostic services or related therapeutic services furnished during the three-day payment window by freestanding medical practices that are wholly owned or wholly operated by the hospital. Rather, the hospital must include those services on the inpatient claim.
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