Proposed Rule Addresses Medicare Claim Denials for Short Stays
March 14—A proposed rule would allow Medicare to pay for additional hospital inpatient services under Medicare Part B, the Centers for Medicare & Medicaid Services (CMS) announced. Specifically, additional Part B payment would be allowed when a Medicare Part A claim is denied because the beneficiary should have been treated as an outpatient, rather than being admitted to the hospital as an inpatient.
Under longstanding Medicare policy, Medicare only pays for a limited number of ancillary medical and other health services as inpatient services under Part B when a Part A claim is denied as not reasonable and necessary. Hospitals have argued that all Part B hospital services provided should be billable to Medicare because they would have been reasonable and necessary if the beneficiary had been treated as an outpatient and not as an inpatient.
The Federal Register will publish the proposed rule on March 18; the comment period ends May 17, 2013.
Publication Date: Thursday, March 14, 2013