CMS Allows Hospitals To Re-bill Claims Denied Due To 'Wrong' Setting-insidehealthpolicy: Hospitals will be able to re-bill payments that were deemed medically necessary but were denied later through audits because care was given in the wrong setting beginning March 13, according to a CMS notice released Wednesday that addresses an issue raised by hospitals in a suit against the agency. CMS also simultaneously released a proposed rule that would allow hospitals to be paid on an outpatient basis if inpatient claims are denied because a patient should not have been admitted to the hospital. One hospital lobbyist said the rule is good news for the industry, and it would relieve pressure on one of the problems connected to hospitals' increasing use of observation status and increased audits by Recovery Audit contractors.
Thursday, March 14, 2013
CMS Allows Hospitals To Re-bill Claims Denied Due To 'Wrong' Setting
CMS Allows Hospitals To Re-bill Claims Denied Due To 'Wrong' Setting-insidehealthpolicy: Hospitals will be able to re-bill payments that were deemed medically necessary but were denied later through audits because care was given in the wrong setting beginning March 13, according to a CMS notice released Wednesday that addresses an issue raised by hospitals in a suit against the agency. CMS also simultaneously released a proposed rule that would allow hospitals to be paid on an outpatient basis if inpatient claims are denied because a patient should not have been admitted to the hospital. One hospital lobbyist said the rule is good news for the industry, and it would relieve pressure on one of the problems connected to hospitals' increasing use of observation status and increased audits by Recovery Audit contractors.
