Corporate Compliance

Did you know? CMS bundling rules

Compliance Monitor, May 9, 2007

CMS hospital outpatient prospective payment system (OPPS) bundling rules prohibit payment to suppliers of the technical component (TC) of radiology services for inpatient stays.

In CMS Transmittal 1221, released April 18, 2007, the agency reminds those billing for hospital radiology services that double billing (billing twice for a service performed only once) constitutes fraud and could lead to greater compliance risks. The basis for the transmittal simply extended the billing date for the TC of physician pathology services based on the Medicare Modernization Act, section 732 and in chapter 16, section 80.2.1.

Nevertheless, the transmittal reminds us that CMS performs reject edits to incoming claims from suppliers of radiology services. And, effective April 1, 2007, for claims with a date of service on or after January 1, 2007, CMS shall install systems edits in its Common Working File (CWF) to prevent additional improper payments for TC or globally billed radiology services provided during a hospital stay.

The CWF will generate an unsolicited response when the line item service date falls within the admission and discharge dates of the hospital inpatient claim.

To read the complete transmittal, click here.

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