Providers have an opportunity comment to CMS on the impact of this policy and the operational difficulty that it may present. In the meantime, they may avail themselves of the CMS ruling before it is superseded by a final rule that again requires inpatient Part B claims to be submitted within timely filing.
If CMS does not extend the timely filing provisions of this ruling when it issues a final rule, it may circumvent CMS's objective. With no relief from timely filing, providers may post discharge utilization reviews and elect to bill close cases as outpatient first, rather than risk losing all payment after a later denial of the inpatient that can't be re-billed, according to Kimberly Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Danvers, MA.
"If they don't fix the timely filing issues, they are simply moving the problem from conservative decisions to keep patients outpatient while in the hospital to conservative decisions to bill patients' care as outpatient following post discharge review. And CMS will not have accomplished their goal of reducing inappropriate outpatient cases that could and should have been inpatient cases," Hoy says.
Hoy adds that close reviews after discharge will be of the utmost importance because under the proposed rule, timely filing is still in place, and some post-payment reviews—especially Recovery Auditors—go back three years, which is prior to the one-year timely filing.
"If this goes through, providers won't be able to just wait for post-payment denials and rebill as they would under the ruling; they will have to be on top of their utilization review (UR) processes to take advantage of this."