Billing for Services After Termination of Provider Agreement

100.4 - Billing for Services After Termination of Provider Agreement (Rev. 1, 10-01-03) HO-404, HH-433 An agreement with a hospital is not time-limited and has no fixed expiration date. A. - Part A Billing A hospital whose provider agreement terminates (voluntarily or involuntarily), may be reimbursed for covered Part A inpatient services for up to 30 days for services furnished on or after the effective date of termination for beneficiaries who were admitted prior to the termination date. EXAMPLE: Termination date: 6/30/01 Beneficiary admitted on or before 6/29/01 Payment can be made: 6/30/01, up to and including 7/29/01 B. - Assuring That Hospitals Continue to Bill for Covered Services Upon cessation of a hospital's participation in the program, it supplies the Regional Office the names and HICNs of Medicare beneficiaries entitled to have payment made on their behalf, and continues to bill for covered services in accordance with subsection A. It continues to submit "no-payment" death or discharge bills for Medicare beneficiaries admitted prior to the termination of the provider's agreement. C. - Part B Billing Following termination of its agreement, a hospital is considered to be a "nonparticipating hospital." An inpatient of such a hospital who has Part B coverage, but for whom Part A benefits have been exhausted, or are otherwise not available, is entitled to reimbursement for those services that are covered in a nonparticipating institution. Services, if rendered, must be billed on Form CMS-1500 and sent to the A/B MAC (B). If a hospital has been billing on the CMS-1554 for physician services, it continues to do so. If a terminated hospital meets the necessary criteria, it may be certified to provide emergency services, and will be assigned an emergency provider number (E suffix). This procedure is not automatic, however, and hospitals which are terminated for Life Safety Code violations may never be able to qualify as emergency providers. Should a terminated hospital later qualify as an emergency provider, billings are handled by the designated emergency FI.