8 Three-Day Rule Tips for Hospitals

James Carroll, August 18, 2010

With the release of the 2011 IPPS final rule on July 30 comes a number of changes that providers will need to have a handle on in regard to the three-day payment window.

The three-day rule states that all diagnostic services provided three calendar days before the calendar day on which the patient is admitted, are bundled and paid as part of the inpatient stay. Non-diagnostic services on the day of and for three days before an admission will now also be considered part of the admission.

Operationally, hospitals have had problems following the three-day payment window rule for years. Hospitals that are scrambling to adapt while trying understand the ramifications of the rule should consider the following list of tips and pitfalls to avoid:

  1. Immediately determine what processes your facility follows in regard to the three-day payment window. How is your facility processing claims, and was it different, or did it deviate from what CMS has in the Claims Processing Manual, Chapter 3, §40.3 manual? If your facility did not strictly follow the Claims Processing Manual, you should look at some test claims. The test should be to see how a claim would have been reimbursed if performed according to the manual and how was it actually reimbursed. Your facility will need to look at both versions to see if in fact they would have had DRG assignments that would have been up-coded or down-coded, or otherwise changed, according to William L. Malm, ND, RN, healthcare consultant for Craneware.
James Carroll James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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