Outpatient Facility Coding Alert - 2007 Issue 27
Don't Stand For X-Ray Denials On Admission Dates
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Article Overview
This article is about a Medicare radiology billing issue tied to hospital admission and discharge dates, with guidance from CMS on denied technical component claims and the appeal process. It is useful for radiology billers, hospital and physician practice coders, and revenue cycle staff who need to understand the scope of the edit, the CMS transmittal mentioned, and the timing of the change.
Why This Topic Matters
It helps billing and coding professionals recognize a denial pattern affecting imaging claims and understand that CMS announced a fix and advised providers to appeal affected denials.
Article Sections
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CMS edit affecting radiology technical component claims
Discusses the Medicare claims edit that led to denials when imaging services were tied to the same date as a hospital admission or discharge. The section frames the issue in terms of radiology billing and payment policy.
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CMS guidance and planned change
Summarizes CMS's explanation of the denial issue and the planned removal of the edit in a later transmittal. It also notes the general direction CMS gave providers regarding denied claims.
What You Will Learn
- The general Medicare billing issue addressed by the article
- Which part of radiology payment was affected
- Why some claims were denied on admission or discharge dates
- What CMS indicated about the future status of the edit
- The type of follow-up action CMS suggested for denied claims
Who Should Read This
- Radiology coders
- Physician practice billers
- Hospital coders
- Revenue cycle staff
- Compliance staff
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