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Proposed Changes to Part B Inpatient Billing Open for Comment

James Carroll, for HealthLeaders Media, March 19, 2013

The Centers for Medicare & Medicaid Services is proposing changes to Part B inpatient billing in hospitals.

CMS issued a notice of ruling March 13, that establishes a policy revising the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor has deemed to be not reasonable or necessary.

The revisions are intended as an interim measure until CMS can finalize an official policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward.

This temporary ruling is effective until CMS finalizes the accompanying proposed rule, which proposes a permanent policy that would apply on a prospective basis. Specifically, CMS is proposing the following:

When a Part A claim for inpatient hospital services is denied because the inpatient admission was deemed not to be reasonable or necessary, or when a hospital determines under § 482.30(d) or § 485.641 after a beneficiary is discharged that his or her inpatient admission was not reasonable and necessary, the hospital may be paid for all the Part B services (except for services that specifically require an outpatient status) that would have been reasonable and necessary had the beneficiary been treated as a hospital outpatient rather than admitted as an inpatient, if the beneficiary is enrolled in Medicare Part B.

While the CMS ruling acquiesces to the current ALJ and Appeals Council rulings to award Part B payment as timely if the original Part A claim was timely, the proposed rule would reverse this ruling and require inpatient Part B claims be filed within the one-year timely filing period.

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