The 72 hour rule is one of the factors that make up the Medicare Prospective Payment System. It states that should a Medicare beneficiary need hospital treatment within 72 hours of a physician visit, diagnostic treatment or receiving medical services, it counts as a single claim.
Examples of services that count towards the 72 Hour Rule:
Exclusion of Other Services
In order to understand the 72 Hour Rule, it is essential to understand the difference between ‘diagnostic’ and ‘other’ services. In order for the 72 Hour Rule to be effective, the diagnostic service must be related to the patient’s complaint; otherwise it must be billed separately.
You must have Medicare Part A coverage to qualify for the 72 hour benefit. If you have any questions about which Medicare insurance plan would best suit your needs, fill out the form at the bottom of this page and one of our representatives will contact you.
Medicare Appeals and Grievances
When you are enrolled in an original Medicare plan, you have the right to appeal if you feel you are being treated unfairly. The first 72 hours after a hospital admission are crucial to your Medicare claim. Find out how in this comprehensive guide.
Healthcare Compliance Plan For Hospitals
There is a three day window where Hospitals can collect on unrelated work done for a patient as long as the 72 hour window applies. Diagnostic services performed within three days prior to hospital admission can be bundled into the DRG payment.