Services included in Inpatient Room and Board

wcookwcook
in REIMBURSEMENT & PAYMENT METHODOLOGIES

We have recently been receiving defense audits from commercial payors.  There have been several services that they are disallowing, stating that these services should be included in the room and board, and fall under routine services.  These payors continue to refer to CMS Provider Reimbursement Manual Chapter 22.


Chapter 22 states that some nursing services are included in the room and board, but what we are finding is that the commercial payors are applying this liberally to include respiratory therapists services, Picc and Midline insertions, and labs performed on an IStat machine, just to name a few.


I have queried our MAC Educator to see if there is something specific out there for CMS, but I am curious to see if other facilities are experiencing the same scenarios, with the commercial payors and what your facility has done in response.


Thank you in advance.


Wendy Cook, CPC

Revenue Integrity Manager

Valley Health System

Winchester VA

Comments

  • valerie@valorizeconsulting.comvalerie@valorizeconsulting.com
    Check the Provider Reimbursement Manual Part 1 chapter 22 - as well as CMS re-published a transmittal that these services can be charged separate with PRM 1 instructions are followed - see R2877CP and R3106CP
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