Impact of Bundled Inpatient Only Procedures

Inpatient only procedures/services that are provided in an outpatient setting can now be bundled into the inpatient billing

Inpatient only procedures/services that are provided in an outpatient setting can now be bundled into the inpatient billing, as long as the services are elated to the admission and if the services were rendered:

• On the date of the admission and/or;
• During the three (3) calendar days before the inpatient admission.

Bundling the inpatient only procedure with the inpatient admission will factor into the MS-DRG calculation.  This MAY lead to and result in an increased DRG inpatient payment.

The recent change, effective 4/1/15, impacts Revenue Cycle and Coding/Documentation processes in a few different ways. Orders for the inpatient only service can be obtained post discharge which means staff will not have to chase the physician prior to the procedure to obtain the admission order. This will allow the physician to focus solely on patient care. In addition, staff will not have to spend valuable time and effort trying to justify the inpatient service being performed as outpatient because of the admission.   As a result, the change reduces related denials and the administrative time working on such denials.  The changes outlined can possibly lead to increases in Medicare revenue and reduced expenses due to the streamlined claim submission process.

The list of inpatient procedures is detailed in Addendum E in the Outpatient Prospective Payment System (OPPS) regulations.