Q&A: Submitting an inpatient Part B claim

February 10, 2020
Medicare Web

Q: How do we bill Part B for an inpatient stay that our UR committee determined was not medically necessary?

A: If the inpatient Part A claim has not already been denied, the provider must first submit a Part A noncovered claim, also known as a “provider liable” claim, on TOB 0110 confirming the hospital will not seek Part A payment for the admission. The inpatient Part A claim must be processed and the remittance advice must be issued prior to billing for inpatient Part B payment. The provider must report the Occurrence Span Code M1 to indicate the period of noncovered care on the Part A claim. The provider must refund any inpatient deductible or copayments to the patient.

For more information, see the Patient Status Training Toolkit for Medicare Utilization Review, Second Edition.