AHA Coding Clinic® for HCPCS - 2006 Issue 2; FOR your INFORMATION

Medicare's three-day window rule and same-day services

Medicare has clarified that the three-day payment window rule replaced the same-day service rule. The same-day service rule required all services, both diagnostic and nondiagnostic, to be bundled with the inpatient claim. CMS has indicated that the three-day payment window rule requires that all diagnostic services provided within three days prior to a patient’s admission (including the day of admission) must be bundled with the inpatient claim, and the nondiagnostic services to be billed separately to Part B (OPPS). Further information on this clarification can be found in Transmittal 7643, Change Request 4047, which was issued by CMS...

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