Answer:
The hospital may submit Part B inpatient claim 12x TOB for Part B services that were furnished during the inpatient admission and would have been payable had the beneficiary originally been treated as outpatient with the exception of services specifically requiring outpatient status (outpatient visits, emergency department visits, observation services). 

The hospital may submit Part B outpatient claim 13x TOB for outpatient services provided before the inpatient admission (within the three-day payment window) such as outpatient visits, emergency visits and observation services.

Reminder: A medically denied 11x TOB needs to be in the claim history in order for the 12x and 13x to process appropriately.

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

Contact a specific JJ Part A department


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