Policy Statement
Our health plan will not allow reimbursement of outpatient charges during an inpatient stay; these services are included in room and board while inpatient. These charges that are not separately reimbursable can include but are not limited to:
- Any outpatient service date(s) that fall completely within inpatient admission and discharge dates, when billed by the hospital and/or provider, or by an entity wholly owned or wholly operated by the hospital and/or provider (or by another entity under arrangements with the hospital and/or provider) are not eligible for separate reimbursement. Provider exclusions can apply as defined by CMS, the health plan, or by contract.
References
None
Cross References
- Adm 129 – Correct Coding Guidelines
- Fac 103 – Reimbursement of Facility Room and Board
