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If the QIO reviews a case billed inpatient and determines the stay involves a billing error (i.e., the physician ordered observation status and did not subsequently order admission), the QIO will issue a Billing Error Claim Adjustment and instruct the provider to rebill on a bill type 13X outpatient claim. However, if the QIO denies the stay as medically unnecessary for the inpatient setting, the QIO will issue an admission denial and claim adjustment. The provider can only rebill for certain ancillary services on a bill type 12x.
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If the QIO denies an inpatient stay, can the provider re-bill the stay as observation?
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