Inpatient Facility Coding & Compliance Alert

Question: Some of the patients getting admitted to the hospital require a private room. What are the guidelines whether or not to charge them extra for the convenience being provided? Please advice.

Texas Subscriber

Answer: Medicare allows a hospital to charge the patient a little extra if the hospital provides both private and semiprivate rooms. However, this applies only when the provision of a private room is not medically necessary and it is provided based on patient request and with prior notification of extra charges.

There are certain circumstances when the provision of a private room is medically necessary. For example, the patient might need isolation when his health condition warrants so to protect both his and the other patients’ health and uneventful recovery by avoiding the risk of cross infection.

In a case where only private rooms are available and the patients require treatment nevertheless, it would still constitute medical necessity. The patient would not be therefore subjected to an extra charge for a private room in an all-private room provider.