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MAC Highlights Common GIP Denial Reason
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If the reason for a patient’s General Inpatient (GIP) stay is not related to the patient’s primary diagnosis, expect to see denials. That’s what a HHH Medicare Administrative Contractor official indicated in a recent Targeted Probe & Educate question-and-answer session. “What we’re looking for is the hospitalizations have got to be related to the primary diagnosis, such as complications related to the primary diagnosis, medication adjustments, observation, or stabilization of symptoms,” the Palmetto GBA staffer explained in a recently posted TPE Q&A set. “Also, GIP is allowed for the patient’s medical condition for pain control, for acute or chronic symptom management.” Bottom line: “The reason for GIP needs to be related to the primary diagnosis,” the MAC source emphasized.
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