Certified Revenue Cycle Representative (CRCR) Practice Exam

How should outpatient diagnostic services be handled if provided within three days of a Medicare beneficiary's admission to an IPPS hospital?

1. They must be billed separately

2. They must be combined with the inpatient bill and paid under the MS-DRG system

3. They can be ignored in the billing process

4. They are deducted from the inpatient bill

The correct answer is: They must be combined with the inpatient bill and paid under the MS-DRG system

Outpatient diagnostic services provided to a Medicare beneficiary within three days prior to an inpatient admission are considered to be related to the inpatient stay. As a result, these services must be combined with the inpatient bill, following the Medicare Severity Diagnosis Related Groups (MS-DRG) system. This process ensures that all relevant services that are related to inpatient care are properly accounted for in the payment methodology, which affects the hospital's reimbursement structure. By bundling these outpatient services with the inpatient services, it ensures that Medicare pays for the care as a comprehensive package rather than as separate entities. This approach also helps to avoid potential discrepancies and ensures that providers are compensated appropriately for the full continuum of care provided to the patient during their hospital stay. Ensuring correct billing under the MS-DRG system is important as it reflects the total services rendered to the patient, which in turn impacts hospital revenue cycle performance and compliance with Medicare policies.