June 16, 2010

72 Hour Rule: Fate Uncertain

By

 

dennisjonesED. NOTE: RACmonitor continues with its ongoing coverage of the 72 Hour Rule as it makes its way through the legislative process. You will find the most recent updates at racmonitor.com. Here is the latest in a continuing series on the 72 Hour Rule from Dennis Jones of CBIZ KA Consulting.

 

There is no such thing as a “sure bet.”

 

The Creating American Jobs and Closing Tax Loopholes Act, which was introduced to the House of Representatives on May 21st and passed on May 28th, was described as a popular bill on the fast track.

 

The bill included the establishment, revision, or extension of more than 50 populist issues including extension of unemployment insurance benefits, elimination of cuts in physician reimbursement, extension of COBRA benefit subsidies, college tuition assistance funding, corporate tax deduction restrictions, small business incentives and property tax breaks.

 

Notably for hospitals, way back in section 525 the bill also included provisions that effectively kill the unbundling and billing/rebilling of outpatient services within 72 hours of an inpatient admission.

 

Note that I speak of the bill in the past tense.

 

After some byzantine legislative moves, the type that seem to be more common these days, the Creating American Jobs and Closing Tax Loopholes Act did not even come up for an official vote.  Acknowledging that, “the numbers just weren’t there,” Senate Majority Leader Harry Reid withdrew the bill and called for a general vote on the general issue of legislation that will increase the already monumental federal deficit.

 

Certainly, it is not the prospect of hospitals’ unbundling and billing/rebilling of outpatient services within 72 hours of an inpatient admission that has killed the bill.  The Clarification of 3-Day Payment Window is one of the few aspects of the bill that would not have either increased the deficit or forced a tax increase.

 

A replacement bill is expected to replace the Creating American Jobs and Closing Tax Loopholes Act.  But as we approach the lazy summer months, who knows when the replacement bill will be introduced? Does this mean that providers should roll the dice and unbundle, recode and rebill “unrelated” outpatient services within 72 hours of an inpatient admission?

 

Each hospital CFO is going to have to make that decision.   Since a replacement bill won’t include all of the features of the original bill, we’ll have to wait and see if the “clarification of the 3-day payment window” is even included.

 

It’s probably just as likely that the 3-day payment window issue will be tacked on to another bill, any other bill, that looks likely to pass House and Senate scrutiny.

 

But as we’ve learned by now, unless your name is Kobe, there are no slam dunks.

 

About the Author

Dennis Jones is the director compliance services for CBIZ KA Consulting. While Dennis is recognized as a leading RAC issues expert, his expertise covers a wide variety of topics including Managed Care, Uncompensated Care, Medicare and Medicaid Compliance, HIPAA, and Process Improvement. As a result he has spoken previously for NJHA, World Research Group, and various state chapters of HFMA, AAHAM, and AHIMA. Dennis is a past-president of the New Jersey Chapter of AAHAM and has held senior management positions in provider, IT vendor and reimbursement consultant arenas. He is a graduate of the Pennsylvania State University with a degree in Health Planning and Administration and hopes to be able to afford season football tickets some day.

 

Contact the Author

drjones@CBIZ.com

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