US · guidance
CMS Pub. 100-04, ch. 3, § 40.3.1
Billing Procedures to Avoid Duplicate Payments
HO-400H
The hospital must install adequate billing procedures to avoid submission of duplicate
claims. This includes duplicate claims for the same service and outpatient bills for
nonphysician services considered included in the DRG for a related inpatient admission in
the facility or in another hospital.
Where the hospital bills separately for nonphysician services provided to a patient either on
the day before admission to a PPS hospital or during a patient's inpatient stay, the claim will
be rejected by the A/B MAC (A) as a duplicate and the hospital may be subject to sanction
penalties per §1128A of the Act.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
257e87de7e3afc32a30dcd865b316d8b8160a4e351e590682b3f213416533b4e
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