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Urology Coding Alert

Reader Question:

Hospital Ownership/Operation Determines Medicare's '3-Day Payment Window' Effect

Published on Sun Jan 16, 2011

Question: I keep hearing about some "three-day payment window" that will affect Medicare payments but I don't know what it is or if my urologists need to worry about it. Can you explain what it is?Kentucky SubscriberAnswer: 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 three days, those prior services are bundled into the patient's hospital stay. This rule has been in place since June 2010 -- however, CMS tweaks the rule effective July 1, 2012, and now it may impact you more.Here's why: If you're in a physician practice that's owned or operated by a hospital and you treat a patient who is subsequently admitted to the hospital within the next three days, you will collect for your service at the facility rate and not at the outpatient rate. This applies to you [...]
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