Revenue Cycle

Q&A: Three-day payment window

Recovery Auditor Report, October 6, 2011

The following is adapted from an actual Q&A between a listener from an HCPro audio conference and Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc.

Q: Are there any detailed guidelines regarding the three-day payment window rule related to physician offices on the CMS website?

A: CMS discussed the inclusion of freestanding hospital-owned physician offices in the FY2012 IPPS Final Rule (see 76 Fed. Reg. 51705 published August 18 for the discussion).  Another good resource is the Medicare Physician Fee Schedule (MPFS) rule, which contained the discussion of the proposed new modifier (see 76 Fed. Reg. 42914 published July 19).

Q: Do Medicare Advantage plans fall under the three-day payment window guidelines as well?

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