IPF Billing Guide - JF Part A
IPF Billing Guide
| Description & Regulation | Inpatient Psychiatric Unit or Free Standing PPS (IPF PPS) |
|---|---|
| Unique Identifying Provider Number Ranges | 3rd digit:
|
| Bill Type |
|
| Payment Type | 15 designated DRG's with Federal Per-Diem base rate + facility level adjustments finalized on last discharge claim |
| Payment Calculators | https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer |
| Frequency of Billing | Bill upon discharge or interim billing after 60 days from admission and every 60 days thereafter as adjustment claim. No need to split claims for provider/Medicare FYE or Calendar years |
| Billing Pre-Entitlement Days Internet Only Manual (IOM), Publication 100-02, Chapter 4, Section 40 | Provider may only bill for days after entitlement if the claim exceeds cost outlier if they were not entitled to Medicare upon date of admission |
| Benefit Period |
|
| Benefits Exhaust IOM, Publication 100-04, Chapter 3, Section 40.2 | Benefits do not exhaust until all 90 days are used in the benefit period and LTR days is at zero for Psychiatric Units. Use A3 Occurrence code for last covered day on claim that exhausts benefits. |
| Same Day Transfers IOM, Publication 100-04, Chapter 3, Section 40.1 | First hospital bills day in non-covered, charges in covered with 40 condition code. Receiving hospital bills claim as usual. Shared DRG would apply |
| Provider Liable Days IOM, Publication 100-04, Chapter 3, Section 40 | If provider liable days are for other than medical necessity or custodial care use 77 occurrence span code. |
| Services Provided at Other Facilities During Inpatient Stay | Psych Facility is responsible for all services provided by other facilities during the inpatient stay |
| 72-hour/24 hour Preadmission Bundling Rule IOM, Publication 100-04, Chapter 3, Section 40.3B | Not subject to 72-hour rule but are subject to the 24 hour bundling rule for preadmission services to be included on the Psych claim for services provided within your campus |
| Same Day Discharge & Readmission | NA-follow interrupted stay policy |
| Leave of Absence Days | NA-follow interrupted stay policy |
| Interrupted Stays/LOA IOM 100-04, Chapter 3, Section 150.9.1.2, 190.7.1 | 3-day interrupted stay with day of hospital discharge and returns by midnight on the 3rd consecutive day. If this occurs this is considered 1 admission with 1 payment and reflected with days billed in non-covered, 74 occurrence span code and 180 revenue code |
| Outpatient Charges During Interrupted Stay | NA-follow Interrupted Stays/LOA policy |
| IP care no longer needed IOM 100-04, Chapter 3, Section 40.2.2 | Use 31 occurrence code for date beneficiary notified through limitation of liability along with 76 span code and 31 value code |
| Ancillary Part B Claims | Billed on 12x TOB when beneficiary doesn't qualify under Part A due to entitlement, benefits exhaust or inpatient stay not medically necessary. |
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