Although CMS made progress in its March 13 proposed rule, the American Hospital Association said the federal agency must do more to allow hospitals to rebill rejected Medicare claims by claiming them under Part B instead.
Hospitals that admit patients and bill them under Medicare's Part A inpatient category, but later are denied payments by CMS because it is determined the patient could have been treated in a less expensive setting, have traditionally been barred from rebilling the patient under Part B, the outpatient services coverage grouping.
The current rule allows hospitals to rebill for procedures within the last 12 months, but the proposed rule would extend hospitals' capacity to do so to all previously rejected claims that were filed in a timely manner originally.
"The proposed rebilling rule will require significant modifications in order to provide hospitals with a fair and equitable process for securing payment for the reasonable and necessary services provided to patients when there is a dispute about the setting in which care should have been delivered," wrote AHA Executive Vice President Rick Pollack in a letter to CMS Administrator Marilyn Tavenner. Among Mr. Pollack's recommendations was a call for the agency to restore hospitals' ability to appeal denials, a right which he says has been narrowed "arbitrarily."
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Hospitals that admit patients and bill them under Medicare's Part A inpatient category, but later are denied payments by CMS because it is determined the patient could have been treated in a less expensive setting, have traditionally been barred from rebilling the patient under Part B, the outpatient services coverage grouping.
The current rule allows hospitals to rebill for procedures within the last 12 months, but the proposed rule would extend hospitals' capacity to do so to all previously rejected claims that were filed in a timely manner originally.
"The proposed rebilling rule will require significant modifications in order to provide hospitals with a fair and equitable process for securing payment for the reasonable and necessary services provided to patients when there is a dispute about the setting in which care should have been delivered," wrote AHA Executive Vice President Rick Pollack in a letter to CMS Administrator Marilyn Tavenner. Among Mr. Pollack's recommendations was a call for the agency to restore hospitals' ability to appeal denials, a right which he says has been narrowed "arbitrarily."
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