The Centers for Medicare & Medicaid Services 72 hour rule states that any outpatient diagnostics or services performed 72 hours or less prior to an inpatient hospital stay must be billed as a part of the inpatient hospital stay and cannot be billed seperately, this is to ensure that the Medicare program runs smoothly billing wise.
Examples of procedures in which the rule applies prior to an inpatient hospital stay:
Sometimes there are times that the hospital may lump in unrelated outpatient services with the inpatient stay, but if the outpatient service is not deemed diagnostic it can be billed seperately.
Easy example of 72 hour rule to follow:
For example, if a beneficiary breaks their leg during a fall and goes to the hospital for x-rays and it is deemed that they will need surgery from the results of the fall. If the surgery takes place within 72 hours of the x-rays at the hospital, then the x-ray charge will be added as part of the inpatient hospital stay bill for the surgery.
Reasoning for the rule:
The main reason that this rule exists is so that Medicare is not double charged for services. If a provider is caught not complying with this rule, they could lose out on payments provided for services they performed as well as be responsible for repayment of overpayments provided by Medicare.
