Reprocessing Inpatient Bills in Sequence

40.2 - Reprocessing Inpatient Bills in Sequence (Rev. 2245, Issued: 06-16-11, Effective: 08-01-11, Implementation: 08-01-11) When a beneficiary experiences multiple admissions (to the same or different facilities) during a benefit period, claims are processed by CWF in the same order that they are received, regardless of the dates on which expenses were incurred. This first-in-first-out method of processing requests for payment facilitates prompt handling of claims. If a SNF, any beneficiary, or secondary insurer have increased liability as a result of CWF’s first-in/first-out (FI/FO) processing, the SNF must notify the A/B MAC (A) to arrange reprocessing of all affected claims. This approach is not applicable if the liability stays the same, e.g., if the coinsurance or deductible amounts are applied on the second stay instead of the first, but there is no issue with regard to the effective date of supplementary coverage or if the beneficiary is responsible for payment of the first claim instead of the second. The A/B MAC (A) will verify and cancel any bills posted out-of-sequence and request that any other A/B MAC (A) involved also cancel any affected bills. The A/B MAC (A) will reprocess all bills in the benefit period in the sequence of the beneficiary’s stays to properly allocate days where payment is made in full by Medicare and to identify those days where the beneficiary is required to pay coinsurance.