If the beneficiary remains in the hospital after receiving notice as described in subsection
C, and the hospital, the physician who concurred in the hospital's determination, or the
QIO, subsequently determines that the beneficiary again requires inpatient hospital care,
the hospital may not charge the beneficiary or other person for services furnished after the
beneficiary again required inpatient hospital care until proper notification occurs
If a patient who needs only a SNF level of care remains in the hospital after the SNF bed
becomes available, and the bed ceases to be available, the hospital may continue to charge
the beneficiary. It need not provide the beneficiary with another notice when the patient
chose not to be discharged to the SNF bed.
Admission Denied
If the entire hospital admission is determined to be not reasonable or necessary, limitation
of liability may apply.
In such cases the following entries are required on the bill:
• Occurrence code 3l (and date) to indicate the date the hospital notified the
beneficiary.
• Occurrence span code 76 (and dates) to indicate the period of noncovered care
for which the hospital is charging the beneficiary
• Occurrence span code 77 (and dates) to indicate any period of noncovered care
for which the provider is liable (e.g., the period between issuing the notice and
the time it may charge the beneficiary) when the provider is aware of this prior
to billing.
• Value code 3l (and amount) to indicate the amount of charges the hospital may
bill the beneficiary for hospitalization that was not necessary or reasonable.
They are included as noncovered charges on the bill.
