Hospital at Home - Is 12X bill type allowed?

goodjegoodje
in BILLING AND CLAIMS

We're working on a new Hospital at Home program, and a question came up about ancillary/12X billing.

Patients must meet standard IP criteria, as well as additional program-specific criteria to be sent home. However, there are cases where payors deny inpatient stays, saying the patient doesn't meet criteria. In cases that aren't won, we can still usually bill a 12X claim for ancillary services. I haven't seen any specific guidelines for Hospital-at-Home ancillary billing. Should we assume it's allowed, since the patients are considered inpatients? Also, does anyone have a workflow or tips they can share to prevent those denials we can integrate into the program creation?

Comments

  • Andrew.ReitenAndrew.Reiten

    I would assume that 12X would be allowed in the exact same circumstances for the use of 12X for Hospital in a Hospital, at least for Medicare. Many non-Medicare payors don't accept 12X at all.

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