Bill Inpatient or Outpatient Services
To help avoid denials, National Government Services has compiled information regarding references that will aid in determining whether to bill inpatient or outpatient services.
CMS Medicare Learning Network (MLN) – Fact Sheet
CMS MLN has created a fact sheet that is a very helpful reference that describes the Two-Midnight Rule. This rule established Medicare payment policy regarding the benchmark criteria to use when determining whether inpatient admission is reasonable and necessary for purposes of payment under Medicare Part A.
CMS Inpatient Only and Procedures Acceptable as Performed in Outpatient Setting
Another helpful tool is the CMS Hospital Outpatient PPS Addendum B Updates. This listing can be used to aid in determining if care can be billed as inpatient or outpatient services. Using the HCPCs code that best describes the procedure needed, find the code and the associated column that lists the “SI” – Status Indicator. SI “C” is used to classify procedures that can only be billed to Medicare in an inpatient hospital setting. These procedures have been determined to require the level of intensity of services in the inpatient hospital setting. Procedures listed with “SI” other than “C” are considered to be appropriate in an outpatient setting. Level of intensity of services would still need to be assessed by the admitting physician in these cases.
Reviewed 11/14/2024
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found atwww.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction
Helpful Resources
CERT Denial Finder
CERT Task Force
CMS CERT Compliance
Options for submitting medical records to CERT
Include barcode coversheet with all submissions.
Option to submit Electronic using esMD:
More information on esMD can be found at www.cms.gov, be sure to route medical records to the CERT Contractor at:
804-261-8100
Option to Mail:
CERT Documentation Center
Attn: CID
8701 Park Central Drive, Suite 400-A
Richmond, VA 23227
Providers mailing documentation via CD should send the password toCERTmail@empower.ai; use the CID number in the subject line of your email (no PHI).
Option to email:
Email documentation in an encrypted emailed to CERT atCERTmail@empower.ai. Password should be submitted in separate email, use the CID number in the subject line of your emails (no PHI).
Questions about medical record submissions
CERT Customer Service:
443-663-2699
Toll Free: 888-779-7477
CERTprovider@empower.ai
Questions about CERT reviews
NGS Provider Contact Center
Select “Contact Us” for phone number per state and jurisdiction