Murtha Means More

DRG Payment Window Expansion: Does It Impact Professional Services Through Your Hospital Physician Practice?

May 8, 2012

CMS has announced a new rule that promises to save the Medicare program very little money, but might generate revenue for the government through False Claims Act recoveries down the road!  Far be it from us to be cynical about the purpose of esoteric Medicare billing rules, but this one is murky and may trap the unwary hospital in a billing error.

The Medicare DRG Payment Window (the "Window") prohibits hospitals from separately billing for outpatient services that are (i) clinically related to an admission and (ii) are provided by an outpatient department or a hospital-operated physician practice within three (3) days of an admission.  The Window essentially "bundles" payment for these technical services into the reimbursement for the admission.

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