decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
DRG 72-Hour Window / Third-party ownership
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Article Overview
This article discusses Medicare DRG 72-hour window policy in the context of third-party ownership and related organizational structures. It is aimed at hospital billing, reimbursement, and compliance professionals who need to understand how ownership and operating relationships affect pre-admission service treatment under CMS guidance. The article presents CMS examples to illustrate the kinds of facility relationships addressed by the policy.
Why This Topic Matters
Ownership and operating relationships can change how pre-admission services are treated for inpatient billing and compliance purposes. Understanding this policy helps organizations evaluate whether services fall within the DRG window and avoid billing errors.
What You Will Learn
- How the DRG 72-hour window is discussed in relation to ownership and operating structures
- The types of hospital and third-party relationships addressed by CMS examples
- How pre-admission services are considered in different organizational arrangements
- Which general service categories are discussed in the context of inpatient billing and compliance
Who Should Read This
- Hospital coders
- Inpatient billing staff
- Reimbursement analysts
- Compliance professionals
- Revenue cycle staff
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