decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
National_Coverage_Determinations_Manual / HOSPITAL_AND_SKILLED_NURSING_FACILITY_ADMISSION_DIAGNOSTIC_PROCEDURES
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Article Overview
This section of the National Coverage Determinations Manual discusses when diagnostic tests furnished on admission to a hospital or skilled nursing facility are considered reasonable and necessary for payment purposes. It is relevant to hospital, skilled nursing facility, and coding/reimbursement staff who need to understand the general coverage framework for admission-related diagnostic services and the role of physician ordering, medical necessity, and duplication concerns.
Why This Topic Matters
Admission-related diagnostic testing can affect whether services are payable, so this guidance helps facilities and billing professionals understand the coverage considerations that apply to these services under Medicare policy.
What You Will Learn
- The Medicare coverage context for diagnostic procedures performed at admission
- The general factors considered in evaluating admission-related diagnostic testing
- The role of ordering, medical necessity, and prior testing in the coverage discussion
- How this manual section fits within hospital and skilled nursing facility admission workflows
Who Should Read This
- Hospital coders
- Skilled nursing facility billing staff
- Revenue cycle professionals
- Compliance staff
- Physicians involved in admission ordering
- Medicare policy researchers
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