Corporate Compliance

Note: Proposed Revisions to the Three-Day Payment Window

Medicare Weekly Update, May 25, 2010

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Editor’s note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the author of this week’s note from the instructor.

The three-day payment window, sometimes known incorrectly as the “72-hour rule,” has received a lot of attention by hospital callers at recent CMS hospital Open Door Forums.  The questions apparently arose from the fact that the RACs were reopening and looking at claims in which hospitals had incorrectly applied the rule and submitted unrelated outpatient services three days before an inpatient admission on the inpatient claim.  The outpatient services should have been billed separately as long as they were “unrelated,” which CMS has previously defined as a different principal ICD-9 diagnosis codes for the inpatient admission and the outpatient service.

Continue reading Kimberly's note on the MedicareMentor Blog.



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