On March 18, 2013, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that allows a hospital to be reimbursed for services under Medicare Part B even when a Part A claim is denied because the beneficiary should have been treated as an outpatient rather than as an inpatient.
Under the proposed rule, Medicare will pay for all reasonable and necessary Part B hospital inpatient services when a Part A inpatient admission is denied as not reasonable and necessary. Under the prior rule, Medicare paid only for a limited list of Part B inpatient services in those circumstances. CMS issued the proposed rule in response to complaints by hospitals that the prior rule was unfair because the Part B services provided to the beneficiary would have been reasonable and necessary if the beneficiary had been treated as an outpatient rather than as an inpatient.
The proposed rule will have to go through a comment period and reevaluation before CMS can finalize it. But in the meantime, the Administrator of CMS has issued a ruling that will implement the policy articulated in the proposed rule before the proposed rule becomes final.
The proposed rule can be found here:
http://www.gpo.gov/fdsys/pkg/FR-2013-03-18/pdf/2013-06159.pdf
David Dirr is an attorney at the Northern Kentucky office of Dressman Benzinger LaVelle and is a member of the firm’s healthcare and litigation practice groups. He is licensed to practice in Ohio, Kentucky, and Indiana. David concentrates his practice on the areas of Medicare and Medicaid reimbursement, anti-kickback law, the Stark law, and HIPAA.
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