tci Medicare Compliance & Reimbursement - 2013 Issue 2
Compliance: Incorrect Reporting Could Be One Of Your Costliest Mistakes
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Article Overview
This article explains Medicare compliance issues tied to the three-day payment window for services furnished in hospital-owned or hospital-operated practices before an inpatient admission. It discusses the general billing and cost-reporting implications for physicians, clinics, and hospitals, including CMS guidance and the use of a reporting modifier. The piece is relevant to coders, compliance staff, revenue cycle teams, and hospital billing professionals who need to understand how these rules affect claim handling and cost allocation.
Why This Topic Matters
Misunderstanding the three-day payment window can affect claim accuracy, reimbursement, and hospital cost reporting. The article helps readers recognize when services may be subject to Medicare bundling and why coordination between professional billing and hospital reporting matters.
What You Will Learn
- How Medicare’s three-day payment window affects services furnished before an inpatient admission
- Why hospital ownership or operation of a practice can change billing treatment
- How CMS-related reporting and hospital cost-reporting issues intersect with physician claims
- What types of compliance concerns can arise when clinic services precede hospitalization
Who Should Read This
- Medical coders
- Compliance officers
- Hospital billing staff
- Revenue cycle professionals
- Physician practice administrators
- Cost reporting personnel
Modifiers Discussed
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