Top Provider Questions – A/B Rebilling
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- Which instruction should be followed for A/B Rebilling claims?
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Please reference the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4, section 240.1.
Reviewed 09/22/2021
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- What is considered as timely filing for the A/B Rebilling claims (12x and 13x type of bills)?
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For admissions on and after October 1, 2013, timely filing restrictions will apply for the Part B services billed. Therefore, Part B claims that are filed beyond 12 months from the date of service will be rejected as untimely and will not be paid. Hospitals are required to maintain documentation to support the services billed on the Part B claim(s).
Reviewed 09/22/2021
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- Where can I locate billing information for "self-audit" claims?
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Please reference the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4, section 240.1.
Reviewed 09/22/2021
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- What condition code should be used on 12x or 13x rebilling claim (s)?
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For admissions occurring on and after October 1, 2013, condition code W2 is only required on 12X rebilling claims.
Reviewed 09/22/2021
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- How can I prevent receiving a duplicate edit on my A/B rebilling claims?
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CMS has been monitoring the processing of A/B rebilling claims and provided the following reminders to ensure the correct processing of these claims.
- First, submit a 12X Type of Bill (TOB) claim for the services that generally occur on or after admission. After the 12X TOB claim finalizes, submit a 13X TOB claim for the outpatient services that generally occur before the admission. This will prevent claims from receiving any duplicate edits in error.
- When appropriate, report CPT modifier 91 for duplicate lab tests that are provided on the same date of service, even if one test is reported on the 13X TOB claim and the repeat test is reported on the 12X TOB claim.
Reviewed 09/22/2021
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