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Briefings on Coding Compliance Strategies (Single Article)
Follow Federal Register three-day window guidelines
December 2005
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HIM professionals and coders commonly roll outpatient services into inpatient admissions, artificially driving up the DRG and depriving their hospital of due outpatient revenue. Or they separately--and inappropriately--bill outpatient procedures to an inpatient.
These claims do not comply with the CMS three-day payment window regulation, but because the fiscal intermediary pays them, many HIM professionals assume that they billed the claims appropriately, says Darlene Fawaz, RHIT, compliance audit specialist for a large acute-care health system in Michigan.
Even though Federal Register guidelines contain proper guidance for billing these services, many facilities don’t bother following the rules due to the added time and effort.
