Inpatient professional charges

solocoder

Expert
Messages
421
Location
Marshfield, MO
Best answers
0
Do our professional charges for inpatient visits/surgeries need to be held until the patient is discharged? Or can we go ahead and submit them? We recently received a denial from a payer because they had not received the facility charges yet. That's the first time I've seen that. Have we just been getting lucky? Or maybe it's a payer thing?
Appreciate any help.

:confused:
 

thomas7331

True Blue
Messages
3,129
Best answers
8
It sounds like a 'payer thing' to me. If the services are complete and documented, there's no requirement to hold the professional charges until discharge. Patients can sometimes be in a facility for a very long time and if that were the case it would mean tying up and delaying a lot of physician revenue.
 

cleanclaims

Networker
Messages
72
Location
Manchester, TN
Best answers
0
I agree. Facilities don't even hold their charges until discharge. Coming from the payor side, we typically do this if there is a question on the claim or if we have multiple providers billing for the same dates. Many states have prompt pay legislation so you can "remind" your payor that your claim should be paid according to those guidelines.
 
Messages
811
Best answers
0
We don't hold our professional charges for inpatients in large part due to the fact that you don't know how long the patient is going to be there. Once a provider signs off on their documentation, the charges are entered and billed out.

Then again, we're a little neurotic about days in A/R so... :rolleyes:

The facility holds off until discharge so they have a "date of discharge" to enter on their claim. Nine times out of 10, though, we still end up with late charges.

As far as timely filing goes, with Medicare at least, they use the "Through" date to start the clock if a claim spans dates of service, which is why we hold the facility charges.
 
Top