Part B services provided during an unauthorized inpatient hospital stay are eligible for rebilling in keeping with CMS guidance, as long as our notification policy is followed. If notification was not provided to us, the Part B services are not eligible for rebilling.
Resubmitted claims need to meet CMS resubmission criteria (available at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1203OTN.pdf). CMS requires the following information on the resubmitted claim, among other information:
- Condition code for Part A to Part B rebilling (also attests that no appeal is in process): W2.
- Treatment authorization code (TAC) for Part A to Part B rebilling: ABREBILLING (indicate the TAC in field FL 63).
- Document control number, which is the word “ABREBILL” plus the original claim number of the denied claim, plus the original denial adjudication date in mmddyyyy format: ABREBILL 1234567890123499999999. Indicate the document control number in field FL 80.
Part B services provided after the point of admission must be rebilled on type of bill (TOB) 121. Part B services provided to the patient prior to the point of inpatient admission (those administered within three days prior to the inpatient admission) but that were originally bundled into the inpatient claim must be rebilled on TOB 131. Resubmission of claims for Part B services waives the right to appeal the charges for the associated Part A services.
For more information about rebilling, reference these Medicare Learning Network (MLN) resources:
- MLN Matters Temporary Instructions for Implementation of Final Rule 1599-F for Part A to Part B Billing of Denied Hospital Inpatient Claims
- MLN Matters CMS Administrator’s Ruling: Part A to Part B Rebilling of Denied Hospital Inpatient Claims