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AHA urges changes to CMS proposed rule on rebilling

May 17, 2013

While the Centers for Medicare & Medicaid Services’ proposed rule on Medicare Part B rebilling recognizes that the agency’s prior policy of denying full payment for Part B claims is unlawful, the rule contains a number of restrictions that would compromise hospitals’ ability to rebill for medically necessary patient services, the AHA told the agency today. “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,” AHA Executive Vice President Rick Pollack wrote in response to CMS’ March 13 proposed rule. The AHA said the final rule should permit rebilling of any denied claim that originally was timely filed, rather than restrict rebilling to services provided in the prior 12 months; ensure full reimbursement of all reasonable and necessary services provided  rather than arbitrarily exclude services that require “outpatient status”; and restore full and fair appeal rights for hospitals that choose to exercise their right to appeal denied claims rather than arbitrarily narrow the scope of that review.