IPF Billing Guide - JE Part A
IPF Billing Guide
Unique Identifying Provider Number Ranges
3rd digit:
- 4 for free standing
- S for Psych units
- M for Critical Access Hospitals (CAH)
Bill Type
- 111 - Admit to discharge
- 112 - 1st sequential
- 117 - Adj or Interim
- 118 - Cancel
- 110 - No payment
Payment Type
15 designated DRG's with Federal Per-Diem base rate + facility level adjustments finalized on last discharge claim.
Payment Calculators
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
- 60 - days paid in full
- 30 - coinsurance days
- 60 - Lifetime Reserve Days
- 190 - Lifetime Psychiatric Days only used for Free-standing Psychiatric facilities. Free-standing Psychiatric facilities need to have 1 benefit day available to use the Lifetime Psychiatric Benefit days.
- Part A Deductible
Benefits Exhaust
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
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
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
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
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
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.
