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CMS has posted the final rule for Part B payment for hospital inpatient services provided under Part B, Medicare’s inpatient admission guidelines, and medical review criteria for inpatient stays. Although the effective date of this final rule is Oct.1, hospitals are allowed to follow the Part B billing timeframes established in the CMS-1455R ruling regarding appeals and the submission of Part B claims after the effective date of the final rule, provided that the Part A inpatient claim denial was one to which the ruling originally applied or that the Part A inpatient claim has a date of admission before Oct. 1 and is denied after Sept. 30 — on the grounds that the medical care was reasonable and necessary, but the inpatient admission was not. For complete details, please see the article written by Wachler & Associates on the home page at racmonitor.com.


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