Question Can I rebill observation if MR doesnt support Inpatient?

mtsoldevila

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McKinney, TX
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I work for an infectious diseases doctor and Wellmed denied my claim for "after reviewing MR, and based on the submitted clinical documentation, this patient doesnt meet for IP status, and the inpatient hospitalization is not medically necessary. Recommended status is Observation"

Does this means that I can correct the claim and rebill as observation with POS 22? I know that only the admitting provider can bill 99218. What CPT can I bill for the consultation? Can I still bill as Observation even when the Patient was IP?
 

sls314

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Local Chapter Officer
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Toledo, OH
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I work for an infectious diseases doctor and Wellmed denied my claim for "after reviewing MR, and based on the submitted clinical documentation, this patient doesnt meet for IP status, and the inpatient hospitalization is not medically necessary. Recommended status is Observation"

Does this means that I can correct the claim and rebill as observation with POS 22? I know that only the admitting provider can bill 99218. What CPT can I bill for the consultation? Can I still bill as Observation even when the Patient was IP?

If possible, I'd confirm what the hospital is doing with their claim.

I used to work in hospital billing. We had a denial nurse who would review these cases - sometimes we would rebill as observation, because it was truly the appropriate status. However, sometimes we would appeal with additional information/support and get the inpatient stay paid/approved as inpatient.

If the hospital is rebilling the stay as Observation, then it should be appropriate to rebill the physician services as well.
 

mtsoldevila

Networker
Messages
26
Location
McKinney, TX
Best answers
0
If possible, I'd confirm what the hospital is doing with their claim.

I used to work in hospital billing. We had a denial nurse who would review these cases - sometimes we would rebill as observation, because it was truly the appropriate status. However, sometimes we would appeal with additional information/support and get the inpatient stay paid/approved as inpatient.

If the hospital is rebilling the stay as Observation, then it should be appropriate to rebill the physician services as well.
thank you
 
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