News: Reversal on inpatient-only procedures in three-day window

As of April 1, CMS will allow inpatient-only procedures to be included on inpatient claims similar to other outpatient services included in the three-day payment window, according to Transmittal 3217.

This reversal of former policy, allowing an inpatient-only procedure provided on an outpatient basis to be covered if the patient is subsequently admitted, provides relief for an issue that has long been a thorn for hospitals and has more recently been aggravated by confusion created by the 2-midnight policy, says Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and compliance for HCPro, in Danvers, Massachusetts.

“This is an issue that always generates a lot of questions in our classes and I had flagged it as one of the biggest potential compliance issues when RACs restart, so this reversal is great news,” Baker wrote.

Editor’s Note: For additional information, review Boot Camp Instructor Judith Kares, JD, article in Medicare Insider.