Health Information Management

CMS discusses the three-day rule, pulmonary rehab

Briefings on APCs, May 1, 2010

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A CMS representative provided follow-up information on the three-day inpatient rule issue. CMS has received questions regarding whether nondiagnostic (therapeutic) services provided during the three calendar days prior to an inpatient admission—but unrelated to the admission—must be billed as inpatient services or may be billed as outpatient services.

The representative cited the Claims Processing Manual, stating that whenever Part A covers an admission under IPPS, the hospital may bill nondiagnostic preadmission services to Part B as outpatient services, only if they are not related to the admission. If there are both diagnostic and nondiagnostic preadmission services and the nondiagnostic services are unrelated to the admission, the hospital may separately bill the nondiagnostic preadmission services to Part B. This Part B billing is at the hospital’s discretion.
 

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