Medical Billing and Coding: Inpatient Billing Guidelines

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Posted on 9th December 2010 by admin in Uncategorized

Inpatient care is billed according to the services given.  Each service has its own fee and each charge is designated on the UB-92 from or in the diagnosis section of the HIPAA X12 837.

Several services can appear on the same claim form.  How this commonly works is the physician will visit the patient once when admitted, once each day that the patient is in the hospital or care facility and on the last day to discharge the patient.  Each visit has a separate charge and can appear on the same claims form.

Medical insurers only allow one visit from a physician on the same day unless there is a medical necessity.  If a more than one physician visits the same patient on the same day, usually only the first visit is covered by medical insurance.

Medical insurers will cover the costs of additional examinations from more than one physician on the same day as long as the primary physician requests the additional review. The purpose of additional visits must be described on each claim.

Medical insurers often require supportive documentation for inpatient claims. The insurer will want to ensure the patient’s diagnosis and the necessity of the procedures performed by the healthcare provider.  Medical reports and notes pertaining to the patient’s condition as well as preformed procedures should be included.  The healthcare provider is often asked to include a letter describing the patient’s condition, treatment and explanation for any extended hospital stay.

To prepare an inpatient claim, the medical billing and coding must identify the proper diagnosis codes that provide the greatest detail about the diagnosis.

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