Q&A: Nonreportable Services

July 26, 2016
Medicare Web

Q. What does it mean when a service is nonreportable for a patient in observation?

A. While some observation services are not covered because they are not considered medically necessary under the payers’ defi­nition, other noncovered services actually fall into the category of nonreportable services. These are services that CMS doesn’t recognize and that should not be listed on the claim at all.

It’s important to note that patients can’t be billed for these services, so hospitals shouldn’t issue an ABN when these conditions apply.

Nonreportable services often relate to system or planning issues within the facility. For example, the physician may decide to discharge a patient, and he or she is ready to leave the hospital but doesn’t have transportation home. In this case, the hospital can still care for the patient, but it’s not covered observation care, according to CMS.

For more information, see the Observation Services Training Handbook.

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