The “3-Day DRG Payment Window”

11/15/2011
The “3-Day DRG Payment Window”
Legal News Alert: Health Care


On November 1, 2011, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the 2012 Physician Fee Schedule, to be published in the Federal Register on November 28, 2011. One of the anticipated sections of the Physician Fee Schedule Final Rule was a clarification of the application of the 3-Day DRG Payment Window for pre-admission non-diagnostic services. The 3-Day Window was long interpreted as applying to diagnostic services furnished in a hospital's provider-based departments or entities. This 3-Day Window required the bundling of all pre-admission diagnostic services furnished within three days of an inpatient admission in the inpatient claim. Medicare also required the bundling of pre-admission non-diagnostic services furnished within three days before the inpatient admission only if there was an exact match of the principal ICD-9 CM diagnosis code for the outpatient encounter and the inpatient admission.
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