1.4	Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission

According to the three-day and one-day payment window reimbursement guidelines, most professional and outpatient diagnostic and nondiagnostic services that are rendered within the designated time frame of an inpatient hospital stay and are related to the inpatient hospital admission will not be reimbursed separately from the inpatient hospital stay if the services are rendered by the hospital or an entity that is wholly owned or operated by the hospital.

These reimbursement guidelines do not apply in the following circumstances:

•	Services are rendered at a federally qualified health center (FQHC) or rural health clinic (RHC).

•	Services are for a THSteps medical checkup.

•	Professional services are rendered in the inpatient hospital setting.

•	The hospital and the physician office or other entity are both owned by a third party, such as a health system.

•	The hospital is not the sole or 100-percent owner of the entity.

These reimbursement guidelines do not apply for FQHC, RHC, THSteps, and professional services that are rendered in the inpatient hospital setting.

Refer to:

Subsection 3.7.3.8, “Payment Window Reimbursement Guidelines” of the Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks) for additional information about the payment window reimbursement guidelines.