|
CMS has guidelines for what to do if certain services are denied under a Part A claim -- some services may still be paid under a Part B claim, but all other rules must still be followed, especially including the rule for timely filing. Below are relevant chapters from the CMS Manuals.
List of Part B Services Covered for Inpatient
Medicare Benefit Policy Manual
Chapter 6 - Hospital Services Covered Under Part B (PDF Format, 163KB, 28 pgs.)
Go to this Section (pg 3): 10 - Medical and Other Health Services Furnished to Inpatients of Participating Hospitals
Billing Outpatient Observation Services
Medicare Claims Processing Manual
Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS) (PDF Format, 1.5MB, 205 pgs.)
Go to this Section (pg 179): 290 - Outpatient Observation Services
ALSO SEE:
Medicare Claims Processing Manual
Chapter 1 - Transmittal 1760, June 2009 (PDF Format, 932KB, 302 pgs.)
Go to pg 9 of the PDF document for "Clarification Related to Observation Services"
Other Resources:
Below are some other important considerations, answering questions we have received from clients.
Time Limitations for Filing (or Refiling) Claims
Medicare Claims Processing Manual
Chapter 1 - General Billing Requirements (PDF Format, 932KB, 302 pgs.)
Go to this Section (pg 177): 70 -Time Limitations for Filing Provider Claims to Fiscal Intermediaries and Carriers
Reporting Hours for Observation Services
Medicare Claims Processing Manual
Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS) (PDF Format, 1.5MB, 205 pgs.)
Go to this Section (pg 180): 290.2.2 - Reporting Hours of Observation
ALSO SEE:
Medicare Claims Processing Manual
Chapter 1 - Transmittal 1760, June 2009 (PDF Format, 932KB, 302 pgs.)
Go to pgs 26-27 of the PDF document for clarifying language added to "Reporting Hours of Observation"
Use of Condition Code 44
Medicare Claims Processing Manual
Chapter 1 - Transmittal 1760, June 2009 (PDF Format, 932KB, 302 pgs.)
Go to pgs. 14-16 of this PDF document for updates to Section 50.3 - When an Inpatient Admission May be changed to Outpatient Status
|
