Update to the Medicare Three-Day Payment Window Rule


On October 29, 2010, the Centers for Medicare & Medicaid Services (CMS) issued a Transmittal entitled “Clarification of Payment Window for Outpatient Services Treated as Inpatient Services” (Transmittal 796), which provides instruction on how to submit claims for outpatient services furnished within three days of an inpatient admission that are unrelated to the admission. This long-awaited instruction flows from § 102 of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (Pub. L. 111-192) (the Act), which changed the definition of admission-related non-diagnostic services furnished on the date of admission or during the three calendar days prior to the date of admission (the “3-day payment window”)1 effective for services furnished on or after June 25, 2010. Section 102 of the Act also requires that all admission-related non-diagnostic services be bundled with the claim for the related inpatient stay. The Act left unclear, however, what constitutes services “related” to an admission.

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