OIG to review expanding Medicare’s DRG three-day payment window

The Office of Inspector General (OIG) will review Medicare’s diagnosis-related group (DRG) window policy to determine whether the program could save money by expanding the policy to include more days, according to an update to the OIG Work Plan.

Under the Medicare DRG window policy, all diagnostic or outpatient services provided the day of and the three calendar days preceding an inpatient admission are bundled with the inpatient services for billing. The OIG will look at how many outpatient services related to an inpatient admission, including services provided more than three days before an inpatient admission or services excluded due to hospital ownership structures, were not covered in the DRG window policy in 2018.

The OIG also plans to interview CMS staff to collect information on other payment models that could be developed to pay for outpatient services related to inpatient admissions.