Updated on: June 22, 2012

RAC ALERT: House Acts to Close 72-Hour Loop

Original story posted on: May 24, 2010

dennisjonesIn legislation that effectively ends the debate on whether hospitals can unbundle and bill any outpatient services that were provided within 72 hours of an admission, The American Jobs and Closing Tax Loopholes Act was introduced to the House of Representatives  as amendment to the Senate's American Workers, State and Business Relief Act.


The House Bill includes language that would prohibit hospitals from billing separately for "other services related to an admission" within a 3 day or 1 day window for acute care hospitals and critical access hospitals, respectively.  When billing for any outpatient services within this timeframe, it would be up to the hospital to prove that the service was unrelated in a manner to be "determined by the Secretary."  Further, the Act prohibits any rebilling of past cases based on this issue.


This Bill will apparently have no impact on RACs' ability to unbundle outpatient services from inpatient services in their efforts to recoup overpayments, particularly for surgical cases where admissions were the result of complications that occurred during surgery or recovery.



The elimination of the 72 Hour Rule "loophole" is just one point in this bill that establishes or extends many popular programs (including a recent COBRA revision.)  Look for it to pass quickly and without much debate.  The full text of the bill can be found at http://waysandmeans.house.gov/press/PRArticle.aspx?NewsID=11185 . The Clarification of the 3-Day Payment Window is found on page 364 of the legislative text.


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

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