265.851 Medicare and Insurance Takeback Procedures
The Medical Society of the State of New York will collaborate with the Healthcare Association of New York State (HANYS) and the AMA to ensure when a patient hospitalization is retrospectively found not to meet criteria for inpatient admission, then the take back amount be only the difference between the cost of the admission and the cost of necessary observation for that patient stay.
MSSNY will collaborate with HANYS and the AMA to ensure that, for any care provided to hospital patients who have Medicare, managed Medicare, or commercial insurance, hospitals have the option to rebill denied inpatient claims as outpatient claims, when a physician using clinical judgment makes a prospective decision to admit a patient who is later found to not meet admission criteria.
MSSNY will also advocate to ensure that the time frame for a public or private payer to audit a claim after payment be limited to the time period that a physician or hospital has to submit the claim to a public or private payer following the delivery of care.
The New York Delegation to the AMA will introduce this resolution for consideration at the next AMA Annual House of Delegates Annual Meeting. (HOD 2016-66)
