CMS guidance on Part B rebilling creates more provider confusion
APCs Insider, May 2, 2014
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by Steven Andrews
…the regular room, dietary and nursing services, minor medical and surgical supplies, medical social services, psychiatric social services, and the use of certain equipment and facilities for which a separate charge is not customarily made to Medicare Part A.
These services are never outpatient services, and therefore are not separately billable Inpatient Part B ancillary services. They include routine nursing services that are captured in the Room and Board rate (such as IV infusions and injections, blood administration, and nebulizer treatments), which are not separately billable Inpatient Part B ancillary services.
- Yes, we’ve carved them out and are dropping CPT codes and charges on Part B 12x claims and are receiving APC/OPPS payment.
- No, we have not carved them out, so we remove the room rate and add applicable charges and CPT codes for various discrete nursing procedures (e.g., infusions and injections) to our Part B 12x claims and are receiving APC/OPPS payment.
- No, we have not carved discrete nursing procedures out of our room rate and we are not dropping charges for these types of procedures. We submit a no-pay Part B 12x claim for which we receive no separate APC/OPPS payment.
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