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https://www.regence.com/provider/library/policies-guidelines/reimbursement-policy/inpatient-hospital-readmissions#:~:text=Readmission%20An%20inpatient%20stay%20which%20occurs%20within%20seventy-two,discharge%20of%20the%20initial%20inpatient%20acute%20care%20admission.
https://medicare-medicaid.com/medicare/the-72-hour-rule-and-medicare-what-you-need-to-know/
If you are a hospital administrator, you should know about Medicare’s 72-hour rule. The 72-hour rule treats outpatient services the same as inpatient services. The rule states that all services provided for Medicare patients within 72 hours of the hospital admission are considered to be part of the inpatient services and are to be billed on one claim.
https://pubmed.ncbi.nlm.nih.gov/21496142/
A multivariate model was created to predict adjusted-resource utilization and mortality or admission rate. Results: Conclusions: Patients who return to the ED within 72 hours do not use more resources, are not more severely ill, and do not have a higher hospital admission rate than those who had not been previously seen. These findings do not support the use of 72-hour …
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program
http://www.hhsc.org/wp-content/uploads/FIN_0514-Outpatient_Services_and_Medicare_Three_Day_Window-72_Hour_Rule.pdf
(72 Hour Rule) Approved by: Thomas M. Driskill, Jr. President & CEO Page: 1 of 7 I. PURPOSE: To ensure Medicare outpatient services provided prior to an inpatient admission are billed in accordance with HCFA regulations. II. POLICY: Medicare outpatient services will be processed as follows: A. Outpatient services will be combined with the inpatient admission when:
https://www.cms.gov/files/document/se20024.pdf
immediately precedes the time of admission but may be longer than 72 hours because it’s a calendar day policy. The 1-day payment window applies to the date of admission and the entire calendar day preceding the date of admission and will include the 24-hour period that immediately preceded the time of admission but may be longer than 24 hours.
http://www.hcpro.com/content.cfm?dp=HIM&content_id=70304
All diagnostic and related non-diagnostic services within 72 hours prior to the date of the beneficiary's admission are deemed to be inpatient services and are included in the inpatient payment, as long as the beneficiary has Part A coverage.
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