CMS Clarifies Three-Day Payment Rule Provisions
In a Medicare Update issued on Friday, June 25, the Centers for Medicare & Medicaid Services (CMS) Office of Media Affairs clarified provisions affecting the three-day payment rule in the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which was signed into law by President Obama also on June 25.
The update states that the new law "clarifies Medicare's policy to be consistent with how hospitals have largely billed the program as far back as 1991." Under the policy, hospitals charge for all diagnostic and non-diagnostic services "related" to the inpatient stay that are provided within a three-day payment window.
The statute makes no changes to the billing of diagnostic services. For non-diagnostic services, the statute clarifies that the term "other services related to admission" includes "all services that are not diagnostic services (other than ambulance or maintenance renal dialysis services) for which payment may be made by" Medicare that are provided by a hospital to a patient on the date of the patient's inpatient admission, or during the three days immediately preceding the date of admission, unless "the hospital demonstrates (in a form and manner, and at a time, specified by the Secretary [of Health and Human Services]) that such services are not related to such admission." If a hospital is not a subsection (d) hospital, the three-day period is reduced to one day.
The three-day payment provisions are effective for services furnished on or after June 25, 2010. The statute also prohibits Medicare from reopening, adjusting, or making payments when hospitals submit new claims or adjustment claims for services that were provided prior to the date of enactment in order to separately bill outpatient non-diagnostic services.
The update also advises that, until CMS provides instruction on how to bill for related therapeutic services provided during the 3-day payment window, hospitals should include charges for all diagnostic and all non-diagnostic services that it believes meets the requirements of the 3-day payment window provision. If a hospital "believes that a non-diagnostic service is truly distinct from and unrelated to the inpatient stay," that service may be separately billed, provided that there is sufficient documentation to support that the service was unrelated, and with the understanding the separately billed service may be subject to subsequent review.
Posted on 7/1/2010 4:15:18 PM
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