How to determine if your hospital-affiliated practice faces new billing rule, pay cuts

Why This Topic Matters

Hospital-affiliated practices may need to evaluate whether a Medicare billing policy applies to them and how claims for certain services are handled around a hospital admission. Understanding the article helps practices identify when to review ownership, operations, and enrollment documentation before making billing changes.

Article Sections

1. Three-day window refresher

   Introduces the billing policy, its timing relative to hospital admission, and the general types of services affected.

2. Billing changes

   Summarizes the claim-level change discussed in the article and the related modifier reference.

3. Ownership details are key

   Explains why hospital-practice ownership and operating structure are central to determining whether the policy applies.

4. 1. Review your practice’s Medicare enrollment form.

   Discusses the role of Medicare enrollment documentation in assessing the practice’s relationship to a hospital.

5. 2. Verify your hospital’s exact legal relationship to your practice.

   Reviews common organizational relationship types and why legal structure matters for policy applicability.

6. 3. Check if your hospital controls the practice’s daily operations.

   Describes operational control factors that may be relevant when evaluating whether a practice is hospital-operated.