Update on the Three Day Payment Window Rule

on Tuesday, 03 August 2010. All News Items

On Friday, July 30, CMS released an interim final rule implementing the provisions of the Preservation of Access to Care Act that addressed changes to the Three Day Payment Window rule.  The comment period for this interim final rule closes on Sept. 28, 2010.

Key points from the rule are:

  • No changes to bundling of diagnostic services
  • All services provided the day of admission are bundled
  • Services within 3-days prior to admission (for IPPS hospitals) are to be bundled if clinically related
  • The inpatient claim must include the diagnosis codes, procedure codes, and charges for bundled outpatient preadmission services
  • If a non-diagnostic covered Part B service is not related to the admission, it should be billed separately
  • CMS will develop a means for the hospital to attest that the service is unrelated (similar to the B4 condition code for same day readmits)
  • Old claims cannot be reopened to adjust the Part A claim or submit new Part B claims after June 25, 2010

The section of the Federal Register notice regarding the Three Day Payment Window is available on the retainer section of the MMP, Inc. website under the Resource Library.  The complete IPPS Final Rule can be viewed at following link (information on the Three Day Rule begins on page 949 of the display document: http://www.ofr.gov/OFRUpload/OFRData/2010-19092_PI.pdf

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