Health Information Management

CMS offers additional guidelines for Part A to Part B rebilling

APCs Insider, April 19, 2013

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CMS released a ruling and a proposed rule for Part A to Part B rebilling March 13. CMS has since released additional guidelines for the ruling in transmittal R1203OTNAs of right now, the ruling is in effect, but when the proposed rule is finalized, the rule will take the place of the ruling.

The ruling applies only to inpatient cases that have been denied as not reasonable and necessary by a contractor:
  • After March 13
  • Prior to March 13, but the timeframe for appeal has not expired
  • Prior to March 13 and an appeal is pending
The ruling does not include a timely filing requirement. Providers should consider expediting any rebilling for claims that have a date of service of more than one year. If the proposed rule is finalized as is, rebilled claims will be subject to timely filing requirements.
To avoid processing problems, however, providers should wait until at least the July 1 implementation date of the transmittal or they receive instructions from their contractor that systems are ready to receive, process, and properly pay claims. In the meantime, find any claims that are subject to rebilling so you are ready on July 1.

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