Health Information Management

News: Rebilling opportunities

CDI Strategies, May 23, 2013

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Recovery Auditor (RA) denials and good news never seem to go hand in hand.

However, CMS announced in an Administrator’s Ruling published March 13 that it would allow full Part B payment for inpatient stays that a contractor denies because it deems them to be not reasonable and necessary. To be eligible for such payment, hospitals must submit a Part B inpatient claim for reasonable and necessary services that would have been payable had the beneficiary originally been treated as an outpatient rather than an inpatient.
Regulations prior to the ruling allowed hospitals to rebill for only a limited number of services after an inpatient denial. These services are often referred to as ancillary Part B services, Part B inpatient services, or Part B only services. The services are included in Chapter 6, Section 10 of the Medicare Benefit Policy Manual. The ruling, which went into effective March 13, allows hospitals to potentially recoup far more than that.
CMS issued instructions stating contractors must address the automation of claims processing by July 1. Until this process is implemented, providers should use these temporary instructions for rebilling Part B inpatient and outpatient claims. On March 22, CMS published Transmittal R1203OTN with instructions for contractors and providers about how the process will work after July 1.
Editor’s Note: This article was originally published on

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