There's a "14 Day Rule" that bundles genomic lab tests to inpatient stays for 14 days after discharge.
Did you know there is also a "3 Day Window" Rule, that bundles lab tests to a DRG, for 3 days in advance of admission?
I wrote a blog explaining the 14 Day Rule for outpatient lab tests in 2015, which is still up - here. The major update since then was a Fall 2017 rule, supposed to be effective January 2018, actually effective January 2020, that genomic tests should be billed by the lab that performed them for outpatient specifics in a 14 day window. See CMS home page for 14 Day Rule here.
I'm gearing up to speak on a panel about the 14 Day Rule and lung cancer patients on October 14, 2021. This is the Foundation for Lung Cancer, Go-2 Summit, CEnters of Excellence Summit. Home page, agenda, and registration here.
14 Day Rule - Background
See 2015 blog for illustrations. The starting point is that the date of service is the date of specimen collection (whether for hospital inpatient or hospital outpatient). This remains the date of service UNLESS a test is ordered by the treating physician more than 14 days after discharge. For an outpatient, the date of specimen collection and "date of discharge" are probably the same. For an inpatient, the date of discharge might even be after the 14th day after the specimen collection.
(For example, a patient is admitted for lung cancer surgery on July 1, has actual surgery on July 2, and is discharged on July 30. The physician orders the genomic test on August 3. The triggering date is a physician order 14 days after discharge (not 14 days after surgery), so the physician order must be August 14 or later to reassign the Date of Service, even though the surgery was July 2.)
However, this applies to the admitting hospital and any wholly-owned entity under it. If I've read some explanatory articles correctly, if Entity A owns Hospital Y and MRI Center Z, then MRI's done at Center Z don't require bundling, because Z is not "wholly owned" by the admitting Hospital Y. (That's my understanding from what I've read, but I'm not an attorney).
- The 2010 law is here, the bundling rule is at Section 102.
- The law is codified at SSA 1886(a)(4). Here.
- CMS isn't given much discretion, because the 72-hour pre-bundling is baked into the hospital payment statute.
- Regulations are 42 CFR 412.2, here.
- Manual instructions are at Inpatient Claims Manual, Ch 3, Section 40.3, here.