June 28, 2010

The Centers for Medicare & Medicare Services soon expects to provide instructions to hospitals on how to bill for related therapeutic services provided to patients within 72 hours of their being admitted to the hospital. The instructions will follow up on a policy change in Medicare’s so-called “72-Hour Rule,” made by the Preservation of Access to Care for Medicare Beneficiaries Act, which the president signed into law Friday. Under the new statute, hospitals are barred from retrospectively billing to unbundled payments for therapeutic services that were provided before the law’s June 25 effective date and that were performed within 72 hours of an unrelated hospital admission. Until contractors issue the new billing instructions, CMS last Friday said a hospital should include on the inpatient claim charges for all diagnostic and non-diagnostic services that it believes were related to the inpatient stay. If a hospital believes it has provided a non-diagnostic service that is unrelated to the patient’s stay, then it can separately bill for that service as long as it has the necessary documentation to make the case for doing so, CMS said. And CMS said hospitals may continue to bill Medicare separately for services provided before June 25 that are unrelated to an inpatient stay – “provided that such a claim meets all applicable filing deadlines and the hospital has supporting documentation that the service is truly unrelated to an inpatient stay.”