tci Medicare Compliance & Reimbursement - 2004 Issue 22

HOSPITALS: When Hospitals Can Bill For Outpatient Therapy

Three scenarios clear the mark,CMS says. Hospitals have long been confused as to when they can and cannot bill Medicare for services provided by their outpatient therapy departments. The Centers for Medicare & Medicaid Services April 23 clarified the rules governing outpatient therapy billing in Transmittal 9. "If a hospital furnishes medically necessary therapy services in its outpatient department to individuals who are registered as its outpatients, those services must be billed directly by the hospital using bill type 13X or 85X for Critical Access Hospitals," the transmittal reads. Here are the situations in which a hospital...

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