decisionhealth Newsletters, Part B News - 2013 Issue 4 (April)
Watch your Part B claims when hospital shifts its place of service
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Article Overview
This article explains a CMS policy change involving hospitals shifting billing from Part A to Part B after inpatient claims are denied as not medically necessary. It discusses why the change matters for Medicare billing operations, timing, and payment flow for hospitals and related physician practices, and it references CMS guidance and industry commentary on the proposal.
Why This Topic Matters
The policy may affect how claims are filed, timed, and processed when a hospital changes a patient’s billing status, which can influence payment coordination for hospitals and affiliated practices. It is relevant to organizations that handle Medicare billing, appeals, and claim submission workflows.
What You Will Learn
- How a CMS policy change can affect hospital billing between Part A and Part B
- Why the timing of claim filing may matter under Medicare billing rules
- How the change could affect billing workflows for physician practices and hospital-owned practices
- What kinds of operational and payment issues are raised by the policy shift
Who Should Read This
- Hospital billing staff
- Physician practice administrators
- Revenue cycle professionals
- Medicare billing specialists
- Compliance and reimbursement staff
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