Admission Date and Statement Covers Period Billing
A common error identified during medical review of hospital inpatient claims is the incorrect admission date billed on claims. The most common issue is the admission date is before the physician order is signed and dated. Noridian reminds providers that the admission date must equal the date the order was written.
Medicare systems allow claims to be processed with the admission date different than the "from" dates.
The day on which the patient is formally admitted as an inpatient is counted as the first inpatient day:
- Admission Date = date patient was admitted as an inpatient to facility. This date is entered on UB04 Form Locator 12 (paper claim) or 837I Loop 2300, Segment DTP (electronic submission)
On the inpatient claim, this is the day on which the patient is formally admitted as an inpatient with a signed and dated physician order. It is the first inpatient day the patient is receiving services.
- Statement Covers Period = span of service dates; "From" date is earliest date of service on bill. This date is entered on UB04 Form Locator 6 (paper claim) or 837I Loop 2300, Segment
On the inpatient claim, a valid "from" date could be up to and including 3-days (or 1 day) prior to the actual inpatient admission based on the pre-admission bundling rule.
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 40
- CMS Medicare Learning Network (MLN) Matters Special Edition (SE)1117
Last Updated Feb 27, 2020