CMS Changes Course on Rebilling RAC-Denied Claims

John Commins, for HealthLeaders Media , March 15, 2013

When Part A reimbursements are denied or rescinded, however, CMS as a matter of policy won't let hospitals re-bill the care under Part B, even if the care is determined to be medically necessary and reasonable.

Although pleased with the new interim rule, Umbdenstock said the lawsuit will continue because "the proposed rule then threatens to undermine the progress made on this important issue."

"Under the proposal, hospitals will be able to rebill CMS only within the narrow time frame of one year from when patient services were provided," he said. "Since the recovery audit contractor typically reviews claims that are more than a year old, the practical effect would be that hospitals would again not be fairly reimbursed for the care they provide Medicare patients." 

"While CMS's interim ruling is a victory for hospitals, its long-term proposed solution is not. That's why it's essential that the AHA continue with our litigation," he said. 

Joining AHA in the suit are: Missouri Baptist Sullivan Hospital, in Sullivan, MO; Munson Medical Center, in Traverse City, MI; Lancaster General Hospital, in Lancaster, PA; and Trinity Health Corp., in Livonia, MI.

The hospitals complain that the CMS policy creates "prolonged uncertainty about whether Medicare will ultimately pay for the services previously provided (and) wreaks havoc on hospital financial planning, including the ability to assess capital and staffing needs. Both the uncertainty and the actual loss of Medicare funds ultimately may adversely affect patient care."

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