Certified Revenue Cycle Representative (CRCR) Practice Exam

Are certain outpatient services provided within three days of admission billed as part of an inpatient stay?

1. A) False

2. B) True

3. C) Only under specific conditions

4. D) Depends on the facility

The correct answer is: B) True

Certain outpatient services provided within three days of a patient's admission can indeed be billed as part of an inpatient stay due to the Medicare guidelines regarding bundling of services. This is known as the "three-day payment window" rule. According to these guidelines, if a patient is subsequently admitted to the hospital, any outpatient services received within three days prior to the admission are considered part of the inpatient stay and must be bundled with the inpatient claim. This rule aims to ensure that related services are appropriately captured for billing purposes and helps to prevent inappropriate shifting of costs between different service types. Understanding this aspect of healthcare billing is essential for those involved in revenue cycle management, as it directly impacts how services are billed and paid. Familiarity with such policies is critical for compliance and optimizing revenue for healthcare providers.