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Rebilling Non-Medicare Inpatient Claims – Is it Observation or Not?

Ronald Hirsch, MD, FACP, CHCQM-PHYADV, CHRI  | Published on 3/24/2021

It is crucial to understand the differentiation between a denial for lack of medical necessity and a denial for incorrect status.

Last week marked the eighth anniversary of the Centers for Medicare & Medicaid Services (CMS) release of ruling CMS-1455-R. This rule allowed inpatient admissions that were previously denied by any Medicare auditor for the incorrect admission status to be rebilled under Part B, even if that rebilled claim...


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