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Need clarification. The person wasn't eligible for Medicare at admission into the hospital, but became eligible while in the hospital? Is this correct?
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A DRG is a diagnosis-related group as defined by medicare. It sounds like the insurance company wants the hospital to bill Medicare instead of them, and maybe they'll pick up whatever Medicare doesn't. Did anyone inform the hospital that the patient is now covered under medicare?
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I'd tell the hospital to bill Medicare or risk not getting a penny from anyone & see how fast they move. ;)
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hosp admission was 5/30 to 6/4/12. Medicare effective 6/1. Ins. rep says hosp should bill as a DRG.
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The hosp is aware but doesn't believe that medicare will pay. The ins co. says that in their experience medicare does pay after which the ins co will address the remaining bill. Some at the hosp is digging in their heels and won't file as an event rather than on a day by day basis. Your responses are greatly appreciated.
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