CMS Proposes Changes to Part B Inpatient Billing Policy

by Shannon Allen

There are just a few weeks left to comment on the Centers for Medicare & Medicaid Services (“CMS”) proposed rule changing the Part B inpatient billing policy.  The proposed rule would rework Medicare Part B billing policies when Part A claims for hospital inpatient services are denied as “not medically reasonable and necessary . . . or when a hospital determines under § 482.30(d) or § 485.641 after a beneficiary is discharged that his or her inpatient admission was not reasonable and necessary.”

The CMS proposes that, “if the beneficiary is enrolled in Medicare Part B,” the hospital may “be paid for all the Part B services . . . that would have been reasonable and necessary had the beneficiary been treated as a hospital outpatient rather than admitted as an inpatient.”  This modified policy would “not apply to any other circumstances in which there is no payment under Part A” (e.g. when a beneficiary depletes Part A benefits for hospital services).

Under this proposal, the hospital could “re-code the reasonable and necessary services” provided as Part B services, and “bill them on a Part B inpatient claim.” The timely filing restriction to Part B inpatient billing would continue to apply.  It is estimated that this change “would result in an approximately $4.8 billion decrease in Medicare program expenditures over 5 years.”

The CMS’s proposal, however, “could create a unique liability issue for Medicare beneficiaries that did not previously exist.”  Beneficiaries, who previously had no “out-of-pocket costs” for a denied Part A claim, would be “responsible for applicable deductible and copayment amounts for Medicare covered services, and for the cost of items or services never covered . . . under Part B . . . .”  The CMS would“conduct an educational campaign and issue materials” to raise “beneficiary awareness.”

Comments should refer to file code CMS-1455-P and must be received by 5:00 PM on May 17, 2013.  Interested parties may comment in only one of the four following ways:  (Note: facsimile (FAX) transmissions cannot be accepted.)

• Electronically. You may submit electronic comments on this document to http://www.regulations.gov. Follow the “Submit a comment” instructions.
• By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1455-P, P.O. Box 8013, Baltimore, MD 21244-8013.
• By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1455-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
• By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
• For delivery in Washington, DC—Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201. 
• For delivery in Baltimore, MD—Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.  If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members.