Awareness : OBC Tips

Billing for Hospital Services

The hospital may bill only for services provided. If the hospital provider billing system initiates billing based on services ordered, the provider must confirm that the service has been provided before billing and submitting the claim to the MAC (A).

The provider agreement to participate in the Medicare program requires the provider to submit all information necessary to support claims for services. Failure to submit such information in an individual case will result in denial of the entire claim, the charging of utilization in inpatient cases to the patient record, and a prohibition against the provider billing or collecting from the patient or other person for any services on the claim.