The CMS 3-Day (or 1-Day) Payment Window presents a complex compliance challenge for hospitals, health systems, and their wholly-owned outpatient departments, ASCs, and physician practices. Missteps in identifying bundled (non-billable) vs. unbundled (billable) outpatient services can lead to audit risks, payment denials, and compliance violations. Admitting providers, revenue cycle teams, and compliance officers must navigate varying time thresholds, inter-facility billing restrictions, and Medicare/Medicaid reporting rules—all while ensuring proper documentation and chargemaster accuracy. Without clear policies, facilities risk OIG scrutiny, financial penalties, and lost revenue.

Hospital compliance expert Michael G. Calahan, PA, MBA, CCO, will break down the 42 CFR regulations, clarify related vs. unrelated diagnostic/therapeutic services, and provide actionable strategies to avoid billing errors. Attendees will learn how to:

• Apply the correct time thresholds (3-Day vs. 1-Day Rule) for different facility types.
• Identify restricted services for pre-admission and inter-facility care.
• Implement compliance safeguards in chargemaster, coding, and revenue cycle workflows.
• Establish facility-to-facility financial agreements to prevent overlapping claims.

Why This Is Relevant:

With the OIG actively auditing improper payments under this rule, hospitals cannot afford non-compliance. Medicare Advantage and Medicaid crossover claims add further complexity. This webcast ensures your team understands current enforcement trends, avoids costly mistakes, and aligns multi-departmental efforts to protect revenue and compliance.

Learning Objectives:

✅ Decipher CMS’s 3-Day/1-Day Rule and its impact on OPPS, CAH, and affiliated clinics.

✅ Correctly classify diagnostic and non-diagnostic services and their restrictions to prevent denials.

✅ Navigate inter-facility billing for “home” vs. “receiving” hospital scenarios.

✅ Train providers & staff on documentation requirements and compliance red flags.

✅ Leverage Condition Codes/Modifiers to flag prohibited vs. allowable services.

✅ Audit-proof your facility with policies for chargemaster, coding, and revenue cycle teams.

Who Should Attend:

Opps Hospitals, Critical Access Hospitals, Hospital Physician Practices, Hospital owned ASCs, C-Suite, Admitting Providers, Physician Practice Administrators, Revenue Cycle Director and Staff, HIM Director, Coders (both IN and OP) Utilization Review Director, QA Director, Compliance Officers and Auditing Teams, Chargemaster Directs and staff.