PAP295 - Payment Integrity Medical Record Review - Definitions updated and added; added categories and listed examples of non-reimbursable items for inpatient claims based on CMS, AMA, CPT, HCPCS and NCCI rules and guidelines; updated references.

Immediately: Billing team must review current inpatient billing practices to ensure services classified as 'routine,' 'integral,' 'inherent,' or 'component' are not being billed separately from primary procedures. Update billing software edits to prevent unbundling of services already included in room and board charges or comprehensive procedure codes. Train coders on new definitions to avoid claim denials and payment recoupments.