Correction to Editing for Inpatient Part B Ancillary 12X Claims When Part A Benefits Exhaust and Manual Updates for Billing of Inpatient Pre-Entitlement Days
The purpose of this change request (CR) is to correct the editing for inpatient Part B ancillary 12X claims for non-physician outpatient services provided within an Inpatient Prospective Payment System (IPPS) hospital admission when Part A benefits exhaust during the inlier portion of the inpatient stay that has exceeded a cost outlier threshold. This CR also includes updates to the Internet Only Manual (IOM) 100-04 Medicare Claims Processing Manual; Chapter 3 Inpatient Hospital Billing for instructions on billing pre-entitlement days.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 10, 2024
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