May 23, 2023
What’s changing?
Effective August 1, 2023 Blue Cross and Blue Shield of Montana (BCBSMT) is implementing a new Coding and Compensation Policy, Outpatient Facility Service(s) Overlapping During an Inpatient Stay. This new BCBSMT policy applies to certain claims that are submitted with outpatient service dates that fall entirely within or overlap the timeframe of an inpatient admission.
The details
Under this new BCBSMT policy:
- Unless otherwise specified in provider contracts/plan documents, outpatient service dates that fall completely within inpatient admission and discharge dates, by the same facility, or an outpatient bill that overlaps an inpatient admission (unless excluded), are not eligible for separate reimbursement. A facility cannot separately bill for outpatient services that were rendered while the member was inpatient.
What do I need to do?
Review in detail the new Coding and Compensation Policy — Outpatient Facility Service(s) Overlapping During an Inpatient Stay.