decisionhealth Newsletters, Part B News - 2011 Issue 12 (December)
Hospital practices to lose revenue, gain billing hassles with 3-day rule
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Article Overview
This article covers a Medicare Physician Fee Schedule final rule that extends a hospital-related three-day payment window concept to certain hospital-owned or hospital-operated entities. It is intended for hospital-affiliated practices, billing staff, compliance teams, and practice administrators who need to understand the policy scope, affected entity types, implementation timing, enrollment-form considerations, and the general billing workflow issues the change may create.
Why This Topic Matters
The policy can affect how affiliated practices are paid for services tied to a hospital admission and may require changes to claim timing, coordination with hospital systems, and internal billing processes.
Article Sections
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Final fee schedule
Overview of the Medicare final rule and its general effect on payment treatment for certain services furnished by hospital-affiliated entities. The section also discusses the timing of the policy change and the broad categories of services involved.
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Who’s affected by the rule
Discussion of the types of hospital-associated entities and enrollment-related factors that determine whether the policy applies. The section also notes categories of practices and facilities discussed as exceptions or exclusions.
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How it will affect your practice
General operational and billing workflow impacts for practices subject to the policy, including claim handling, coordination with hospitals, and system access challenges. The section also mentions the introduction and timing of a new billing modifier.
What You Will Learn
- What the article says about the Medicare final rule and its purpose
- Which kinds of hospital-affiliated entities are discussed as potentially affected
- What general administrative and billing issues practices may need to address
- How the article frames the timing and implementation of the policy change
Who Should Read This
- Hospital-affiliated medical practices
- Practice administrators
- Billing and coding staff
- Compliance staff
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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