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CMS releases guidance on pre-entitlement billing

   August 08, 2023

CMS released compliance tips for pre-entitlement billing in a recent edition of its MLN Connects® newsletter. The agency instructed providers to use these billing instructions for inpatient admissions when the patient is admitted before their Medicare Part A entitlement date and discharged after that date.

CMS calculates the number of utilization days from a patient’s Part A entitlement date through their discharge, transfer, or death date and reimburses providers based on the amount of billed covered charges, according to the guidance. For Inpatient Prospective Payment System claims, the agency calculates the diagnosis-related group from the patient’s admission date.

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