Wiki Radiation oncology billing

[cpatty476]

Is it correct for insurance to recoup 77386 if it is within 30 days of an inpatient stay? Where can I find guidelines regarding this?

 

[sls314]

Is it correct for insurance to recoup 77386 if it is within 30 days of an inpatient stay? Where can I find guidelines regarding this?

Which payer? Was the service rendered in POS 22 (outpatient hospital)?

What were the treatment dates and what was the admission/discharge on the inpatient stay?

 

[cpatty476]

77386 was billed for 0131 outpatient on UB. DOS 4-18 & 4-19. Then patient was in the hospital 4-21 through 5-1 UB POS 0111. Anthem Medicare payer.

 

[sls314]

77386 was billed for 0131 outpatient on UB. DOS 4-18 & 4-19. Then patient was in the hospital 4-21 through 5-1 UB POS 0111. Anthem Medicare payer.

I suspect those charges will need to be added to the inpatient bill.

I'm not sure what state you're in, but here in Ohio state law specifies that Outpatient services provided within three calendar days prior to the date of admission in hospitals will be considered Inpatient services.

(OAC 5160-2-02, General provisions: hospital services, (G) Inpatient Services)

 

[cpatty476]

Thank you!