IPF Billing Guide

Description & Regulation Inpatient Psychiatric Unit or
Free Standing PPS (IPF PPS)
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 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
  • 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

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.

 

Last Updated Thu, 17 Nov 2022 21:18:06 +0000