Facilities: Effective Oct. 1, additional services may be payable for Medicare members moved from inpatient to outpatient
For claims with a date of service Oct. 1, 2019 or after, we may pay for certain Part B services for Medicare members if a determination is made post-discharge that a Medicare member should not have been admitted or if the admission is denied due to lack of medical necessity.
Previously, if a determination were made post-discharge that a patient’s hospital stay did not meet inpatient criteria, we would not allow for claim submissions using a type of bill 12x.
How should these services be billed?
Billable services should be submitted with bill type 12x.
Codes not included in this change
The revenue codes shown below represent services that are not billable as inpatient ancillary services and should not be submitted on a bill type 12x.
|Revenue Codes not covered under inpatient Part B medical necessaity denials
*Revenue code 0964 is used by a hospital that has a CRNA exception.