On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” Among other provisions, this law clarifies Medicare’s policy for payment of services provided in hospital outpatient departments on either the day of or during the three days prior to an inpatient admission (known as the 3-day payment window).
The new law clarifies Medicare’s policy to be consistent with how hospitals have largely been billing the program as far back as 1991. Under this policy, a hospital (or an entity wholly owned or operated by the hospital) includes in its charges for the inpatient hospital stay charges for all diagnostic services and non-diagnostic services “related” to the inpatient stay that are provided during the 3 day payment window.
In the very near future, CMS expects to provide instructions to the hospital community through its contractors advising them how to bill for related therapeutic services provided during the 3- or 1-day payment window. Until the instruction is issued, hospitals should include charges for all diagnostic services and all non-diagnostic services that it believes meet the requirements of this provision. If a hospital believes that a non-diagnostic service is truly distinct from and unrelated to the inpatient stay, the hospital may separately bill for the service provided that it has documentation to support that the service is unrelated to the admission, consistent with the new provision.
For further details, go to this link.