New requirements for hospital billing. If you don't bill for hospital charges, lock this away for future reference.
When a patient admits to a hospital, and Medicare does not think they meet the criteria for an inpatient stay, you have to perform what is known as A/B rebilling. There will be a video from CMS linked below. Basically what happens is this:
Hospitals are expected to self-audit for appropriateness. If the criteria is not met, they must:
Bill the entire stay for a denial (as a tob 110 indicating it is a denial billing)
Bill the Part B ancillary charges only (tob 121)
and then bill any bundled charges prior to admit separately (131 tob).
This is a very tedious and time consuming process, but a necessary one these days. Check out the link below for complete instructions straight from CMS.
Until next time:
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Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.