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New CMS rules address rebilling

March 13, 2013

In two rules released today, the Centers for Medicare & Medicaid Services proposes to revise its position on rebilling for claims denied by Medicare contractors, including recovery audit contractors. Based on a preliminary review of the regulations, it appears that hospitals will generally be eligible for Part B payment following the denial of a Medicare Part A claim, for those services that would have been reasonable and necessary had the beneficiary been treated as a hospital outpatient. “We view this proposed rule as a positive development and will continue to work with CMS to ensure that hospitals are fully reimbursed for the care they provide to our nation’s seniors,” said AHA President and CEO Rich Umbdenstock. Last year AHA filed suit against the government on the rebilling issue. AHA staff is reviewing the rules to determine whether they resolve the issues raised in the lawsuit. AHA members will receive a Special Bulletin with further details tomorrow.