Medicare Fee-for-Service Compliance Programs: Part A to Part B Rebilling Demonstration

Part A to Part B Rebilling Demonstration Ended March 14, 2013

The demonstration ended because on March 13, 2013 a CMS ruling became effective which ends the demonstration. Demonstration participants were emailed additional information. If you are a participant and did not receive demonstration end information please contact CMS at ABRebillingDemo@cms.hhs.gov. More information on the ruling can be found below.

Administrator’s Ruling “Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B)” may be located at: http://www.ofr.gov/(X(1)S(vp32o25ckyhpvspfpzx3owe4))/OFRUpload/OFRData/2013-06159_PI.pdf.

A proposed rule which was simultaneously released, and is entitled “Medicare Program; Part B Inpatient Billing in Hospitals” may be found at: http://www.ofr.gov/(X(1)S(vp32o25ckyhpvspfpzx3owe4))/OFRUpload/OFRData/2013-06163_PI.pdf.

In addition, CMS has provided a fact sheet for provider reference, which may be located at: /apps/media/press/factsheet.asp?Counter=4558.  

The comment period for the proposed rule ends on May 17, 2013.

• 3/1/2012 - Due to recent provider inquiries, applicants will now be accepted and placed on an ongoing wait list for the Part A to Part B (AB) Rebilling Demonstration. Interested providers are encouraged to review the materials posted below to determine their facility eligibility prior to submitting their application. Please note: All enrollment applications (or questions) should be sent to ABRebillingDemo@cms.hhs.gov for review. Please do not send requests to the size specific email boxes as initially indicated on the enrollment application.
• 12/22/2011 - The enrollment process for the Part A to Part B Rebilling Demonstration has now closed. Applicants will receive notification by e-mail of their acceptance/non-acceptance into the demonstration on or before December 30, 2011.

Part A to Part B Rebilling Demonstration

Allows participating hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting. Currently, when outpatient services are billed as inpatient services, the entire claim is denied in full. This demonstration is limited to a representative sample of 380 hospitals nationwide that volunteered to be part of the program. This demonstration allows hospitals to resubmit claims for 90 percent of the allowable Part B payment when a Medicare Administrative Contractor, Recovery Auditor, or the Comprehensive Error Rate Testing Contractor finds that a Medicare patient met the requirements for Part B services but did not meet the requirements for a Part A inpatient stay. In addition, this demonstration is expected to lower the appeals rate which will protect the trust fund and reduce hospital burden. Beneficiaries will be held harmless with respect to changes in hospital coinsurance liability. 

This demonstration began on January 1, 2012. See below "Related Links Inside CMS" for more information.

Contact: ABRebillingDemo@cms.hhs.gov

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