Certified Revenue Cycle Representative (CRCR) Practice Exam 2026 - Free CRCR Practice Questions and Study Guide

The three-day DRG (Diagnosis-Related Group) window rule encompasses all diagnostic and clinically-related non-diagnostic charges provided on the three days immediately preceding the patient’s admission, as well as the day of admission itself. In this scenario, the patient is admitted on a Friday, meaning relevant services would include those provided on Tuesday, Wednesday, Thursday, and Friday. This rule is designed to ensure that comprehensive costs relating to the patient’s condition are considered when determining payment for the hospital stay under Medicare.

The reason this option aligns with the three-day rule is that it captures comprehensive care that may have been necessary leading up to the admission, ensuring that the hospital receives appropriate reimbursement for all related services. The inclusion of services from the previous week or only from the admission day does not account for the full spectrum of care that might influence a patient's condition at the time of admission.

Additionally, by focusing on the specific three-day window, it encourages hospitals to maintain thorough documentation and billing practices that accurately reflect all necessary treatments prior to hospitalization, leading to fair reimbursement practices in line with Medicare guidelines.