{"id":7821,"date":"2022-06-16T16:55:39","date_gmt":"2022-06-16T11:25:39","guid":{"rendered":"https:\/\/www.medisysdata.com\/blog\/?p=7821"},"modified":"2022-10-11T19:15:16","modified_gmt":"2022-10-11T13:45:16","slug":"understanding-3-day-payment-window-for-outpatient-billing","status":"publish","type":"post","link":"https:\/\/www.medisysdata.com\/blog\/understanding-3-day-payment-window-for-outpatient-billing\/","title":{"rendered":"Understanding 3-Day Payment Window for Outpatient Billing"},"content":{"rendered":"

What is 3-Day Payment Window?<\/h2>\n

Medicare\u2019s 3-day (or 1-day) payment window applies to outpatient services that hospitals and hospital wholly owned or wholly operated Part B entities furnish to Medicare beneficiaries. The statute requires that hospitals bundle the technical component of all outpatient diagnostic services and related non-diagnostic services (for example, therapeutic) with the claim for an inpatient stay when services are furnished to a Medicare beneficiary<\/a> in the 3 days (or, in the case of a hospital that is not a subsection (d) hospital, during the 1 day) preceding an inpatient admission in compliance with Section 1886 of the Social Security Act.<\/p>\n

Defining Wholly Owned or Wholly Operated<\/h2>\n

In general, if a hospital has direct ownership or control over another entity\u2019s operations, then services that other entity provides are subject to the payment window policy. However, if a third organization owns or operates both the hospital and the entity, then the payment window provision doesn\u2019t apply. Given the multitude of possible business and financial arrangements that may exist between a hospital and a physician practice or other Part B entity, CMS won\u2019t make individual determinations as to whether a specific physician practice or other Part B entity is wholly owned or wholly operated by an admitting hospital.<\/p>\n

Defining Diagnostic Services<\/h2>\n

Non-diagnostic services include any non-diagnostic service that\u2019s clinically related to the reason for a patient\u2019s inpatient admission, regardless of whether the inpatient and outpatient diagnoses are the same. A service is \u201cdiagnostic\u201d if it\u2019s an exam or procedure to which you subject the patient, or which you perform on materials derived from a hospital outpatient, to get information to aid in your assessment of a medical condition or to identify a disease. Among these examinations and tests are diagnostic laboratory services such as hematology and chemistry, diagnostic x-rays, isotope studies, EKGs, pulmonary function studies, thyroid function tests, psychological tests, and other tests you give to determine the nature and severity of an ailment or injury.<\/p>\n

Hospital subject to 1-Day Payment Window<\/h2>\n

The hospital and hospital units subject to the 1-day payment window policy (instead of the 3-day payment window) are:<\/p>\n