Lobbying Affiliate: MML&K Government Solutions
{ Banner Image }

Healthcare Law Blog

Comprehensive Healthcare law services.
It's kind of our bag.

Contact Us

250 Character(s) Remaining
Type the following characters: foxtrot, whisky, niner, six, foxtrot

* Indicates a required field.

Categories

McBrayer Blogs

Related Blogs

Showing 1 post in Medicare Benefit Policy Manual.

CMS Ruling on Part B Rebilling

Increasingly, Administrative Law Judges (“ALJs”) and the Medicare Appeals Council were upholding Part A denials on RAC audit appeals based on determinations that inpatient admissions were not reasonable and necessary, and then ordering payment under Part B as if services were rendered at an outpatient or “observation level” of care. The problem with this practice is that Medicare Benefit Policy Manual (“MBPM”) allows hospitals to bill a Part B inpatient claim for only a limited set of medical and other health services. Additionally, the providing for payment of all reasonable and necessary Part B services under these circumstances are contrary to CMS policy that the services be billed within the usual timely filing restrictions. The Centers for Medicare & Medicaid Services (“CMS”), concerned about this practice, recently released both a Ruling and a Proposed Rule to seemingly help the hospital community. How much relief it will actually provide is yet to be seen. More >

Lexington, KYLouisville, KYFrankfort, KYFrankfort, KY: MML&K Government Solutions