HCPro, JustCoding Inpatient - 2015 Issue 12 (March)
Healthcare News: CMS changes policy on inpatient-only procedures and three-day window
March 25th, 2015
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Article Overview
This healthcare news item reviews a CMS transmittal that changed how inpatient-only procedures may be treated when a patient is later admitted, in the context of the three-day payment window and inpatient claim processing. It is aimed at hospital coders, billers, CDI staff, revenue cycle professionals, and compliance teams who need to understand the operational and reimbursement impact of the policy update. The article also discusses how the change can affect MS-DRG assignment and notes that additional questions remain about implementation.
Why This Topic Matters
The policy change can affect which services appear on the inpatient claim and may alter hospital reimbursement through MS-DRG assignment. Readers need to know about the update to evaluate claim handling, documentation timing, and financial impact.
What You Will Learn
- The scope of a CMS policy change involving inpatient-only procedures and inpatient claims
- How the three-day window context relates to hospital billing and claim inclusion
- Why the change may affect Medicare severity DRG assignment
- What kinds of operational questions the update raises for hospital reimbursement workflows
Who Should Read This
- Hospital coders
- Inpatient billers
- CDI specialists
- Revenue cycle staff
- Compliance professionals
- Medicare reimbursement staff
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