July 23, 2014

Medicare Part B Rebilling: Centers for Medicare and Medicaid Services Releases Proposed Rule

On Wednesday, March 13, 2013, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that allows payment for additional hospital inpatient services under Medicare Part B.  The proposed rule affects all hospitals, including critical access hospitals. 

The proposed rule allows hospitals to submit a Part B inpatient claim when a Part A claim is denied as not reasonable and necessary because the beneficiary should have been treated as an outpatient. The proposed rule also allows hospitals to submit a Part B inpatient claim when the hospital determines post-discharge that the patient’s inpatient admission was not reasonable and necessary.  However, hospitals must rebill CMS within one year of the date of service in order to take advantage of this Part B inpatient rebilling option.

Once the rule is finalized, hospitals may bill Part B inpatient claims for all Part B services that are reasonable and necessary, except for services that require an outpatient status or in circumstances where there is no Part A payment.  This expands Part B billing options from the limited set of payable Part B inpatient services currently allowed under Medicare policy.

In such a case, hospitals are required to submit a provider-liable Part A claim to assist accurate financial and cost sharing data and to cancel any claim that may have been submitted under Part A. After submitting a provider-liable Part A claim, hospitals can then submit a Part B inpatient claim and can expect reimbursement so long as:

  • The Part B inpatient claim has services that would have been reasonable and necessary if the beneficiary had been treated as an outpatient; and
  • The Part B inpatient claim is submitted within 1 year after the date of service.

CMS also published a ruling (CMS-1455-R) outlining a process for handling pending appeals and billing for additional Part B inpatient services while the proposed rule makes its way through the rulemaking process.

Comments on the proposed rule are due by May 17, 2013.

©2014 von Briesen & Roper, s.c

About the Author

Patrick J. Cannon, Health and Business Law Attorney with von Briesen law firm

Patrick Cannon is a member of the Business, Health, and Compensation and Benefits/ERISA Law Sections. His practice focuses on mergers and acquisitions, corporate entity formation and continued growth strategy, commercial contract negotiation and drafting, general health law, and all areas of employee benefits law including health, welfare, corporate pension, 401(k), profit sharing, and non-qualified deferred compensation programs, among others.

Prior to joining von Briesen, Patrick worked as General Counsel for MediRevv, Inc., a health care revenue cycle management company. As...


Boost: AJAX core statistics

Legal Disclaimer

You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's  Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on are intended for general information purposes only. Any legal analysis, legislative updates or other content and links should not be construed as legal or professional advice or a substitute for such advice. No attorney-client or confidential relationship is formed by the transmission of information between you and the National Law Review website or any of the law firms, attorneys or other professionals or organizations who include content on the National Law Review website. If you require legal or professional advice, kindly contact an attorney or other suitable professional advisor.  

Some states have laws and ethical rules regarding solicitation and advertisement practices by attorneys and/or other professionals. The National Law Review is not a law firm nor is  intended to be  a referral service for attorneys and/or other professionals. The NLR does not wish, nor does it intend, to solicit the business of anyone or to refer anyone to an attorney or other professional.  NLR does not answer legal questions nor will we refer you to an attorney or other professional if you request such information from us. 

Under certain state laws the following statements may be required on this website and we have included them in order to be in full compliance with these rules. The choice of a lawyer or other professional is an important decision and should not be based solely upon advertisements. Attorney Advertising Notice: Prior results do not guarantee a similar outcome. Statement in compliance with Texas Rules of Professional Conduct. Unless otherwise noted, attorneys are not certified by the Texas Board of Legal Specialization, nor can NLR attest to the accuracy of any notation of Legal Specialization or other Professional Credentials.

The National Law Review - National Law Forum LLC 4700 Gilbert Ave. Suite 47 #230 Western Springs, IL 60558  Telephone  (708) 357-3317 If you would ike to contact us via email please click here.