Wiki Inpatient Auditing Questions

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amessmer1067

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Good afternoon all,
I am looking for resources to identify what is included in the inpatient charge, and guidance on MUE in the inpatient setting as well as what is included in an ICU daily charge. We are having a roundtable trying to firm up our guidance/guidelines and would appreciate any assistance given in this area. Thank you!!
 
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amessmer1067 said:
Good afternoon all,
I am looking for resources to identify what is included in the inpatient charge, and guidance on MUE in the inpatient setting as well as what is included in an ICU daily charge. We are having a roundtable trying to firm up our guidance/guidelines and would appreciate any assistance given in this area. Thank you!!
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By inpatient charge, what specifically are you referring to? The room and board revenue codes, or the entire inpatient facility claim?

MUE doesn't apply to inpatient claims.

Refer to the CMS NCCI MUE page, and you'll see the reference that it is for Part B claims: Medicare NCCI Medically Unlikely Edits | CMS

Inpatient claims don't generally report specific units of a specific service. All of the items get rolled up into the revenue code and billed in aggregate. For example, you're not going to report line item units for 10 different lab codes - you'll roll them all up into one line for each lab revenue code.

Keep in mind that services still need to be medically necessary and documented appropriately. An inpatient claim can be audited to confirm that all the charges on your UB-04 and itemized statement were supported by documentation.
 
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In regards to the "inpatient charge" part of the question, I'm looking moreso for the inclusive services in in the ICU daily charge. For example, we see chest xray's as high as 10 units billed daily being billed on an ICU DOS.
 
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amessmer1067 said:
In regards to the "inpatient charge" part of the question, I'm looking moreso for the inclusive services in in the ICU daily charge. For example, we see chest xray's as high as 10 units billed daily being billed on an ICU DOS.
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Room and board charges on an inpatient claim include the overhead charges for the actual room (ex - utilities, cleaning, maintenance, etc) and the nursing staff. Think of it as the hospital's charges for having that room available and nursing staff on hand. Regular dietary services would be included in room and board too. (Parental or enteral nutrition would be itemized separately.)

Diagnostic testing, labs, radiology, pharmacy, etc. - those things are all separate charges.

If you're questioning whether the services billed were performed and medically necessary for a specific patient, you'd need a documentation review. Every patient's case could be different, based on their diagnoses and co-morbidities.

Do you work for the facility or the payer? Just trying to make sure that I'm covering what you need to know for the specific purpose you need.
 
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Good morning all! I come with another inpatient question. A facility bills the anesthesia base charge and then bills the anesthesia drugs separately. I need some input as to what the guidelines are for this from the inpatient perspective as well as any resource to support.

Thank you in advance! :)
 
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