May 31, 2023
Effective Sept. 1, 2023, Blue Cross and Blue Shield of Illinois is implementing a new Clinical Payment and Coding Policy, Outpatient Facility Service(s) Overlapping During an Inpatient Stay (CPCP039), utilizing guidance from the Centers for Medicare & Medicaid Services.
Under this new BCBSIL 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 are not eligible for separate reimbursement.
- As a result, the facility cannot separately bill for outpatient services that were rendered while the member was inpatient at the same facility.
What do I need to do?
Review in detail the new policy – Outpatient Facility Service(s) Overlapping During an Inpatient Stay, CPCP039.