Under a final rule that reverses previous proposals,
inpatient therapy services may be rebilled if Medicare denies a beneficiary's inpatient stay.
As of the first of this month, hospitals, critical access
hospitals, inpatient rehabilitation facilities and long-term care hospitals can
rebill Medicare Part B for payment of therapy services provided during a denied
Part A inpatient stay. The claims must include the necessary procedure codes
and functional outcome reporting G-codes.
The Centers for Medicare and Medicaid Services was compelled
to re-evaluate the inpatient hospital billing policy after the Medicare Appeals
Council and administrative law judges overturned a significant number of Part A
inpatient claims that were denied because the inpatient admission was
determined not reasonable and necessary. The judgments required Medicare to pay
for services as if they had been rendered at an outpatient or "observation level" of care, clearing the way for hospitals to bill Part B for the services and requiring reimbursement as if the beneficiary had received outpatient, rather than inpatient, services.
In the proposed rules issued in March, CMS expanded the list
of services that could be rebilled under these conditions, but excluded therapy
services, determining that therapy services are legislatively defined as
outpatient-only services. Under this assumption, hospitals could not have
rebilled Medicare for any therapy services provided in the inpatient setting,
and rehabilitation departments would have lost revenue.
ASHA submitted comments on the proposed rule, illustrating
inpatient speech-language services and explaining the legislative definition of
the services. The final rule reflects this comment, and determines that it is
appropriate to pay for the Part B inpatient therapy services when the patient's hospital admission is determined not reasonable and necessary under Part A.
Rebilled services will be included in the therapy cap,
contrary to ASHA's request that they not be included and that they not be subject to functional outcome reporting and manual medical review. CMS maintains that any therapy services billed to Part B must adhere to all of the Part B therapy provisions.
Speech-language pathologists providing services in inpatient
settings may want to include the appropriate G-code in the patient's medical record in case it is needed for a Part B claim. ASHA recently modified its National Outcomes Measurement System to help SLPs report G-codes. NOMS now automatically generates G-codes and
severity modifiers for all patients entered into the database. Organizations
participating in NOMS can easily search for records in the system and retrieve
G-code information at any time.