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| APC Payment Insider |
| September 2008 |
| Unraveling the costly inpatient-only procedures puzzle |
| Few CMS rules are as confusing as those for inpatient-only procedures performed in outpatient settings. Although CMS appears interested in learning when such procedures are justified, many believe the current process penalizes facilities that pass along the information.
The basic rule for billing inpatient-only claims, reiterated in quarterly OCE updates, is as follows: If a physician performs a procedure on the inpatient-only list (OCE Addendum B) on an outpatient basis, and the procedure appears on a claim, the OCE denies the entire claim and returns it to the provider. |
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