Corporate Compliance

Regulations: CMS clarifies three-day rule, posts vaccine proposal

Medicare Update for Physician Services, June 2, 2011

CMS clarifies three-day rule and physician offices

As part of its recently released proposed rule for the inpatient prospective payment system, CMS has clarified its three-day payment window in relation to services provided at physician clinics or offices that are wholly owned by a hospital (though not necessarily provider-based). CMS is affirming that the window—which requires payment for certain services to be bundled into the inpatient DRG reimbursement if provided within three calendar days of an inpatient admission—applies to both preadmission diagnostic and non-diagnostic services furnished to a patient at physician’s practices that are wholly owned or wholly operated by the admitting hospital. CMS states that it will provide further details on billing under this situation in the physician fee schedule final rule to be released later this year.

View the proposed rule.

Read more about this clarification.

CMS publishes flu vaccine proposal

On May 4, CMS published in the Federal Register a proposed rule that would require certain Medicare and Medicaid providers and suppliers to offer all patients an annual influenza vaccination, unless medically contraindicated or unless the patient or patient’s representative or surrogate declines vaccination. This requirement is intended to increase the number of patients receiving annual vaccination against seasonal influenza and to decrease the morbidity and mortality rates from influenza.

View the proposed rule.

Comment on the proposal.

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