3-Day Payment Window Services

The 3-Day Payment Window policy is a longstanding Medicare policy, but one with which most hospitals still struggle, with most being under-reimbursed as a result. Complying with the regulations and receiving due reimbursement requires more than simply bundling eligible outpatient services provided to a patient within three days of admission to inpatient care.

MedPar data and existing MCare client hospitals are proving that many current industry practices are not only resulting in significant underpayment, but are actually not in compliance with the 3-Day regulations. MCare proprietary systems allow hospitals to separate outpatient charges that can be unbundled and submit those to Part B. Working collaboratively with medical record and patient accounting staff, MCare will code the OP/ER record, identify charges that can be unbundled, and submit a file to the hospital for creation and coding of an ER account and subsequent billing and payment follow up.

For same day ER admissions, MCare will, at the hospital’s request, go beyond the regulations and ensure there is no match between the ER principal diagnosis code and any of the inpatient diagnosis codes. MCare exceeds requirements of the regulations in order to ensure our clients are not subject to payment retractions that may result from subsequent coding review by the FI, QIO, or RAC.

Additional Information

3-Day-Payment Window Regulations Examples of 3-Day Payment Window UNbundling Calculator FAQs