decisionhealth Newsletters, Part B News - 2019 Issue 7 (July)
Billing an outpatient who’s an inpatient? Bill where they’re admitted, not treated
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Article Overview
This article addresses a Medicare billing question involving outpatient physician services provided to a patient who is also an inpatient at another facility within the same system. It explains the policy context behind place-of-service reporting, references CMS manual guidance and related FAQs, and helps billing and coding staff understand why the claim review issue may have arisen.
Why This Topic Matters
Place-of-service reporting affects whether claims are aligned with Medicare policy and can influence audit outcomes. Revenue cycle, billing, and coding teams need this guidance to evaluate similar scenarios involving inpatient status, outpatient services, and interfacility ownership relationships.
Article Sections
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Question
A billing scenario involving outpatient care, inpatient status at another hospital, and a review of how the charge was reported.
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Answer
An explanation of the relevant Medicare place-of-service policy, including the CMS manual source and the general reporting context for services delivered to beneficiaries in hospital settings.
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Resources
Referenced CMS guidance documents and supporting materials related to place-of-service policy.
What You Will Learn
- How Medicare place-of-service policy applies in a cross-facility billing scenario
- Which CMS guidance sources are cited for place-of-service reporting
- Why audit reviews may focus on where a beneficiary is registered versus where care was delivered
- What supporting resources are referenced for further policy review
Who Should Read This
- Hospital billing staff
- Coding professionals
- Revenue cycle staff
- Compliance teams
- Physician practice administrators
Codes Discussed
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