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From LoveToKnow Insurance

Comments

Lisa,

Each situation is different and can be handled differently under the 72 hour rule. To be really sure of what you are going to be charged, I suggest that you contact the Social Security hotline at 1-800-MEDICARE.

-- Contributed by: SusanWeber

I also would like to know what happens to the professional E&M charge in a provider based practice with regards to the 72hr rule. I suspect it is included. If someone could provide a resource to support that it would be greatly appreciated!

-- Contributed by: Lisa

It's likely that the E&M portion of the visit is billed to Medicare as a part of the total visit, but check with the clinic to find out how the billing is charged.

-- Contributed by: Tamsen Butler

How would the E&M charge portion of a hospital-based clinic visit be treated under the 72 Hour Rule?

-- Contributed by: Hans Schermerhorn

There are additional condsiderations regarding the 72 Hour Rule when it comes to insulin overdose by a diabetic patient, but for specific questions regarding other overdoses contact a Medicare representative, or hospital billing representative, for details.

-- Contributed by: Tamsen Butler

i was wondering what the 72 hour rule was when it came to overdoes in the community and any additional information tht could be given...

-- Contributed by: Alisa

Nicole,

I would assume that the 72 hour rule would not apply since the EKG was completed as an outpatient. I suggest that you contact the hospital for their interpretation.

Thanks for your question and for visiting LoveToKnow Insurance.

-- Contributed by: SusanWeber

Does this rule apply in this scenario:

Patient visits PCP in FL has an EKG. The next day goes on vacation to NJ and later that night has chest pain and gets admitted to the hospital. Would the PCP EKG bill need to be cancelled?

Does it matter if the outpatient service is not afiliated at all with the facility?

-- Contributed by: Nicole

Patrick,

In most cases, the timing on the 72 hour rule would start with the first admission - the one for observation. To verify how the rule works in your particular situation, you should discuss your details with your hospital admittance office.

Thanks for your question!

-- Contributed by: SusanWeber

What if a pt is an outpatient "observation" from 11/02/08 to 11/03/08 and discharged home.PT comes back as a "direct admit" inpatient on 11/06/08,would you add the 11/03/08 portion of the OP-OBV to the Inpatient,as that dos only is within 72 hours,or do you go by when the outpatient actually started,which is beyond 72 hours...

-- Contributed by: patrick gross

Lurie,

An ER visit would be billed with the hospital costs if there was 72 hours or less between the two events. You should check with your hospital admittance office to double check your particular situation.

Thank you for your question.

-- Contributed by: SusanWeber

Does The 72 hour rule apply if the 65 yo patient was seen in the ER discharged, returned and was then admitted. The response says seen just in the ER

-- Contributed by: Lurie forney

David,

In most cases the 72 hour rule would apply if the patient was readmitted for complications of the first admit. A quick call to the hospital would certainly clarify this for your specific situation.

Thanks for your question and for visiting LoveToKnow Insurance.

-- Contributed by: SusanWeber

Does 72 hour rule apply to subsequent IP admits for comlication of previous admit?

-- Contributed by: David Thompson

Arthur,

Yes, the 72 hour rule applies if the over 65 patient is seen in just the ER.

Thanks for your question and for visiting LoveToKnow Insurance.

-- Contributed by: SusanWeber

Does the 72hour rule for patients over 65 still apply if the patient is seen in just the ER only

-- Contributed by: arthur sidrow

The answer to your question is based on whether the second visit to the ER is directly related to the problem presented on the claim for the first visit. You should not assume that the system will recognize any overlap.

I encourage you to directly contact Social Security if you have any questions.

Thank you for your question and for visiting LoveToKnow Insurance.

-- Contributed by: SusanWeber

What is a facility supposed to do if they already submitted a claim for services, and the patient presents at the facility ER within 3 days with an unexpected problem that requires admission? Is the hospital supposed to go in and cancel the previously submitted claim? or will the system recognize an overlap when the claim for the unexpected hospitalization is submitted?

-- Contributed by: K Duncan

Odetta,

The rule is applied differently based on the type of medical facility. You should contact Medicare directly at 800-MEDICARE (800-633-4227), identify yourself as a Medicaid patient and they will be able to answer your question based on your specific situation.

Thank you for your question and for visiting LoveToKnow Insurance.

-- Contributed by: SusanWeber

Does the 72 hour rule for Medicare also apply to a Medicaid patient?

-- Contributed by: Odetta Shafer
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