Outpatient Facility Coding Alert - 2012 Issue 1
Beware: Medicare's '3-Day Payment Window' Could Impact Your Practice
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Article Overview
This article covers a Medicare policy change discussed in the context of the 2012 Physician Fee Schedule and its potential impact on physician practices owned or operated by hospitals. It is aimed at surgeons, practice administrators, and medical coders who need to understand the general scope of the rule, the related billing implications, and the modifier mentioned in the article. The discussion includes a practical example involving a clinic service and subsequent hospital admission, with emphasis on how the policy affects claim handling and facility-related payment considerations.
Why This Topic Matters
Practices owned by hospitals may be affected by whether services fall within the three-day payment window, which can change how claims are processed and what revenue is associated with the service. Understanding the policy helps practices evaluate billing risk and anticipate documentation and claim-reporting impacts.
Article Sections
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Hospital Ownership Triggers Rule
This section introduces the Medicare payment window policy in the setting of hospital-owned or hospital-operated physician practices. It explains the broad circumstances that bring the policy into play and notes the timing discussed in the article.
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Use this modifier:
This section discusses the modifier referenced in connection with the policy and includes an example scenario involving a surgical practice and a subsequent inpatient admission. It also describes the general billing impact referenced by the article.
What You Will Learn
- How the article frames the Medicare three-day payment window in relation to hospital ownership
- Which kinds of practice ownership arrangements are discussed
- What general billing and claim-processing issues the article highlights
- How a modifier is referenced in connection with the policy
- How the article uses an example to illustrate the policy context
Who Should Read This
- General surgeons
- Physician practice administrators
- Medical coders
- Billing staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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