This is what's posted on our Medicare contractor's website, see link:
I pasted it in also, in case the link didn't work:
MM7142 â€“ Clarification of Payment Window for Outpatient Services Treated as Inpatient Services
Effective for dates of service on or after June 25, 2010, the following is clarification of Medicare policy for payment of outpatient services on either the date of an inpatient admission or during the three calendar days immediately preceding an inpatient date of admission:
Under the three-day payment window, a hospital (or an entity that is wholly owned or wholly operated by the hospital) must include on the inpatient claim the diagnoses, procedures and charges for all outpatient diagnostic services and admission-related outpatient non-diagnostic services provided during the payment window.
All services, other than ambulance and maintenance renal dialysis services, provided by the hospital (or an entity wholly owned or wholly operated by the hospital) on the same date of the inpatient admission are deemed related to the admission and are not separately billable.
Outpatient non-diagnostic services, other than ambulance services and maintenance renal dialysis services, provided by the hospital (or an entity wholly owned or wholly operated by the hospital) on the first, second and third calendar days (first calendar day for non-subsection (d) hospitals) preceding the date of a beneficiaryâ€™s admission are deemed related to the admission and must be billed on the inpatient claim.
A hospital can attest to specific non-diagnostic services as being unrelated to the inpatient hospital claim (the preadmission non-diagnostic services are clinically distinct or independent from the reason for the beneficiaryâ€™s admission) by reporting condition code 51 on the separately billed outpatient non-diagnostic services claim.
Effective: June 25, 2010
Implementation: April 4, 2011
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