Part A to Part B Billing of Denied Hospital Inpatient Claims
When an inpatient admission is found not to be reasonable and necessary, CMS will allow payment of all hospital services that were furnished and would have been reasonable and necessary if the beneficiary had been treated as an outpatient rather than an inpatient. This excludes services that specifically require an outpatient status and that are provided to hospital outpatients and not inpatients. These services include outpatient visits, emergency department visits, and observation services. For more information, refer to MLN Matters® Article SE1333 (PDF) .