Inpatient Facility Coding & Compliance Alert

Check behind physicians to ensure correct reimbursement rates.   Medicare implemented changes to the "three-day payment window" for 2012, but some coders still question whether they handle situations correctly. Be sure you’re in the know because incorrect reporting can be one of your facility’s most costly mistakes. The basics: If a Medicare patient has services furnished in a facility wholly owned or operated by a hospital and then gets admitted to that hospital within the three-day window, those prior services may be required to be bundled into the patient’s hospital stay. There are really two parts to the window, says Duane Abbey, Ph.D., president of Abbey and Abbey Consultants, Inc., in Ames, Ia.: the three dates of service prior to the date of admission and the hours on the date of admission before the actual admission. "For the three days prior to the admission, all diagnostic services must be bundled, but [...]