What does the 72 Hour Window Rule pertain to?

The 72 Hour Window Rule specifically relates to billing requirements for outpatient diagnostic tests. This rule is in place to ensure that certain outpatient services, including diagnostic tests, that are performed within a 72-hour period before an inpatient admission are considered integral to the patient's hospital stay. As a result, these services may be bundled into the inpatient reimbursement rather than billed separately. This bundling helps prevent overcharging and ensures that patients' previous outpatient services are accurately accounted for in relation to their inpatient care. Understanding this rule is essential for healthcare providers to navigate billing processes properly and maintain compliance with reimbursement policies.