Part B Inpatient Billing When Inpatient Admission Denied

on Tuesday, 26 March 2013. All News Items | Billing

On March 13, 2013, CMS released a ruling (Ruling 1455-R) with a HUGE impact for hospitals. The Ruling allows hospitals to bill and receive payment for all reasonable and necessary Part B services provided to a hospital inpatient when a Medicare review contractor denies the Part A inpatient admission as not reasonable and necessary. Although the ruling is effective immediately, hospitals cannot submit claims until final billing instructions are issued by Medicare. On Friday, March 22, 2013, CMS released Transmittal 1203 (CR 8185) which details the claims requirements for Part B rebilling. Although this transmittal is effective March 13, 2013, the implementation date is not until July 1, 2013.

So What Are Hospitals To Do Now

So what are hospitals to do now, especially if they have a claim that was denied prior to the date of the ruling that is approaching the end of the appeal timeframe? MMP, Inc. received the following information from a CMS representative:

  • Hospitals cannot bill under the instructions of CR8185 until July 2013.
  • Additional guidance on how to bill in the interim is expected to be released very soon (possibly later this week) by CMS or the regional Medicare contractors.
  • If you have a denied claim that has not been appealed and is approaching the end of the appeal timeframe, you should appeal the claim now in order to reserve your right to request a dismissal and bill under Part B once the billing instructions are released.
  • It appears the interim billing instructions will be the same as the instructions for the A/B Rebilling Demonstration.

A detailed discussion of the specifics of the ruling will be in tomorrow’s Wednesday@One.

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it. .



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