AHA Challenges Provisions of CMS Proposed Rule on Medicare Part B Rebilling

May 22, 2013 | Strategic Insights for Health System


The Centers for Medicare and Medicaid Services’ (CMS) March 13, 2013, proposed rule to permit hospitals to rebill under Medicare Part B for the reasonable and necessary care provided to patients after denial of an inpatient Part A claim contains a number of provisions that would, in practice, seriously compromise hospitals’ ability to rebill when there is a dispute about where services should have been provided, states Rick Pollack, executive vice president of the American Hospital Association (AHA) in a May 17, 2013, comment letter from AHA to CMS. As written, the proposed rule would permit hospitals to rebill most services under Part B after a Medicare contractor determines that hospital inpatient services should have been provided in an outpatient setting; however, unlike the current Administrator’s Ruling that allows hospitals the choice to rebill or challenge a payment denial through the appeals process, the proposed rule erects “artificial and arbitrary” limits on the time frame and methods to submit any rebilled claim, the letter states. Although the Administrator’s Ruling is temporary and limited in the time period it covers, AHA asserts that is far preferable to the proposed rule in a number of respects and that CMS should adopt the less restrictive limits on rebilling contained in the ruling on a permanent basis through publication of a final rule.

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