Understanding the 3-Day Payment Window

3- Day DRG Payment Window! Let us understand what it really means!

Learn from, Duane Abbey as he shows you how to:

• To review the concept of the 3-Day DRG Pre-Admission Window.
• To discuss the associated 1-Day Window for special hospitals.
• To assess the changes made to the Social Security Act (SSA) as of June 25, 2010.
• To review associated Federal Register entries.
• To review the concept of determining related therapeutic services under the window.
• To discuss operational concerns for properly applying the window.
• To discuss the ‘wholly owned or wholly operated’ trigger for the window.
• To appreciate how provider-based status affects the window.
• To explain how physician billing and reimbursement is affected at hospital owned freestanding clinics under the 3-day window.
• To understand how the OIG views the 3-Day Pre-Admission Window.
• To appreciate how MS-DRG grouping can be affected by the inclusion of outpatient services in the window.
• To work through several case studies.

Plus, take a peek:

I.    Review of the 3-Day Pre-Admission Window

  a.    Bundling Outpatient Services into Inpatient Billing
  b.    Diagnostic vs. Therapeutic
  c.    Related Services
  d.    Wholly Owned or Wholly Operated
  e.    3-Day Window vs. 1-Day Window
II.    Changes to the SSA Language

  a.    Change to §1886(a)(4)
  b.    Interpretation of Changed Language
  c.    Federal Register Discussions

III.    Concept of Related Diagnostic Services
  a.    Formula Prior to June 25, 2010
  b.    Guidance for Definitions After June 25, 2010
  c.    Operational Implications for Meeting the New Requirements

IV.    Hospital Owned or Operated Freestanding Clinics
a.    3-Day Window Impact on Physician Billing and Reimbursement Under the MPFS
b.    Physician Incident-To Billing Impact
c.    Compliance Responsibilities

V.    Additional Considerations
  a.    Anticipated Guidance
  b.    OIG Pronouncements
  c.    MS-DRG Implications
  d.    Application to Critical Access Hospitals (CAHs)
  e.    Provider-Based Status Implications

VI.    Action Steps to Maintain Compliance

VII.    Case Studies

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? Patient Financial Services Personnel, Business Office Staff, Compliance Personnel, Financial Analysts, Information Technology Personnel, Health Information Coding Staff, Interested Clinical Personnel

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