| Hospital Services |
If California’s Medicare Administrative Contractor (Noridian) denies a payment to the hospital can they also deny the physician’s claim associated with the denied hospital service?Yes, they can! If the MAC denies the hospital claim for an inpatient stay the patient becomes an outpatient for that stay. If the physician billed an inpatient E/M service to Noridian they will likely deny that E/M service because the category no longer matches the patient status as determined by the MAC. The physician would need to re-bill the appropriate outpatient E/M service if the denial is still within the timely filing limitation.