Humana sometimes reviews an itemized bill for an inpatient admission to determine whether supplies, items and services specified on the itemized bill are separately billable. If an itemized bill is not provided when requested, or if improper billing is identified during the review of an itemized bill, one or more of the following outcomes may result:
- Reimbursement reduction
- Payment recoupment
- Denial of specific charges
Humana's Itemized Bill Review for Inpatient Routine Services policy can be found on the Humana claims payment policies page. Type "itemized bill review" in the search box.
Please note that Humana's Provider Administration Manual indicates that a hospital agrees to comply with Humana's hospital audit and prepayment review policies. In addition to Humana's Itemized Bill Review for Inpatient Routine Services policy, you may wish to review the following:
- Itemized Billing Claims Payment policy; type "itemized bill" in the search box.
- Humana Provider Payment Integrity (PPI) Prepayment Review policy
- Humana PPI Postpayment Review policy