Revenue Cycle

CMS demonstration allows rebilling outpatient services after some inpatient denials

Briefings on Coding Compliance Strategies, February 1, 2012

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Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or M­AC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the ­inpatient claim.

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