Certified Revenue Cycle Representative (CRCR) Practice Exam

Under Medicare rules, certain outpatient services must be billed as part of an inpatient stay if they occur within what time frame?

1. Within 24 hours of admission

2. Within three days of the admission date

3. Within one week of the admission date

4. At any time prior to discharge

The correct answer is: Within three days of the admission date

The correct choice focuses on the requirement that outpatient services related to an inpatient stay under Medicare must be billed as part of the inpatient stay if they occur within three days of the admission date. This regulation is crucial because it prevents providers from separately billing Medicare for outpatient services that should be considered part of the overall inpatient care being provided. Medicare has established this three-day rule to ensure that services that are necessary prior to the formal admission—such as certain diagnostic tests or treatments—are encompassed within the inpatient claim, thus ensuring comprehensive and appropriate billing practices. By doing this, it helps to limit fragmentation in billing and assists in the accurate capturing of patient care costs associated with an inpatient stay. The time frame specified is significant because it provides clear guidelines for healthcare providers about which services must be bundled together for billing purposes when a patient transitions from outpatient to inpatient status. This prevails in upholding the integrity of Medicare billing and helps mitigate the risk of improper billing or claims denials. Other time frame options mentioned—such as 24 hours, one week, and any time prior to discharge—do not align with the specific Medicare guideline of three days for the inclusion of outpatient services in the inpatient billing process, highlighting the importance of understanding the precise requirements of Medicare