Hospitals want changes to proposed rebilling rule

Hospitals are raising objections to a proposed rule that would allow them to rebill the Medicare program for Part B claims that had been denied by auditors based on the setting where the care was rendered, reported AHA News Now.

According to a letter written by American Hospital Association Executive Vice President Rick Pollack, the current rule has several flaws. That interim rule was issued by the Centers for Medicare & Medicaid Services in March after the AHA and other provider groups sued. 

As a result, the AHA is asking that a 12-month time limit for rebilling be lifted, given that many audits occur more than a year after the original claim was filed. The AHA also wants to lift a requirement that bars rebilling if some of the care--such as physical and occupational therapy and observation services--requires outpatient status.

The AHA also wants to widen the scope of review for rejected claims offered to administrative law judges.

The proposed rebilling rule will require significant modifications in order to provide hospitals with a fair and equitable process for securing payment for the reasonable and necessary services provided to patients when there is a dispute about the setting in which care should have been delivered.

"The proposed rebilling rule will require significant modifications in order to provide hospitals with a fair and equitable process for securing payment for the reasonable and necessary services provided to patients when there is a dispute about the setting in which care should have been delivered," Pollack wrote.

To learn more:
- read the AHA News Now article
- check out the letter

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