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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Article Overview
This article covers Medicare/CMS guidance on the relationship between the three-day payment window rule and the earlier same-day service rule. It is relevant to hospital coders, billing staff, compliance teams, and revenue cycle professionals who need to understand the general scope of the billing guidance and the CMS transmittal cited in the update.
Why This Topic Matters
Understanding this Medicare clarification helps organizations recognize which services are addressed by the rule change and where the official CMS guidance was issued.
What You Will Learn
- How Medicare describes the change from the same-day service rule to the three-day payment window rule
- The general categories of services discussed in relation to inpatient bundling and separate billing
- Where to find the cited CMS clarification document and when it was issued
- How the update affects readers working in hospital billing and compliance
Who Should Read This
- Hospital coders
- Medical billing staff
- Revenue cycle professionals
- Compliance staff
- Health information management professionals
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