American Jobs & Closing Tax Loopholes Act of 2010

Legislation has recently announced a bill that would close the 72-hour rule loophole that allows re-billing. The effective date is unknown at this point to the public.

The name of the amendment is the American Jobs and Closing Tax Loopholes Act of 2010; HR 4213.

At multiple Open Door Forums, CMS repeatedly told hospitals that they could not 'bundle' all ER charges automatically to an inpatient admission unless the diagnosis codes for both were an exact five-digit match. Both RACs and QIOs have penalized hospitals for 'bundling' same day surgeries to an inpatient stay when the patient was later admitted, when diagnosis codes for both were not an exact five-digit match.

Therefore, many hospitals have been designing a process to:

• Separately code the outpatient scenarios.
• Send adjustment claims for outpatient services, prior to the patient's admission, if the diagnosis codes were not an exact five-digit match (following the Medicare Claims Processing Manual).

It's important for hospitals to give feedback to their representatives regarding the language of this act.