room and board what's included how to stop denials

We have a few insurance companies denying outliers based on supplies charges (rev) codes. How do we determine what rev codes / supplies should not be on the inpatient itemized bill. Any suggestions on how to appeal these?


  • ask your Compliance officer to read their issue of Report on Medicare Compliance that arrived yesterday. Nina Youngstrom wrote about it- 
    • Payers Deny Separate Charges Using Their Own Policies, Pay Less Than Contracted Rates
      In their unbundling audits of hospital bills, some commercial payers are denying payment for items and services charged separately based on their policies, not Medicare language. The payers have been using the Medicare Provider Reimbursement Manual to support their position that hospitals can’t bill separately for routine and ancillary services provided during hospital stays, but there was pushback from hospitals, which contend the payers were misapplying CMS’s words. Now some payers are reverting to their own policies, a hospital official says…

  • Thanks! I knew something is up, we are seeing a trend with several denials Aetna being a major one! We are fighting these but it's not easy.
  • Seeing a trend with this and Cigna.  Anyone else having this issue with Cigna?  If so, are you having success fighting them on not paying based on their policies?  Any information on how to fight these denials would be greatly appreciated.
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