IRF Billing Guide - JE Part A
IRF Billing Guide
Requirement | Description |
---|---|
Unique Identifying Provider Number Ranges | 3rd - 6th digits:
|
Type Of Bill (TOB) |
|
Billable Visit CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 1, Section 110 42 CFR §§412.622(a)(3), (4), and (5) | Documentation Requirements (110.1)
Medical Necessity Criteria (110.2)
|
Physician | Rehabilitation physician or other licensed treating physician with specialized training and experience in rehabilitation |
Interdisciplinary Team | At a minimum, the team consists of:
The interdisciplinary team is led by the rehabilitation physician. Periodic team conferences are held at least once per week |
Revenue Codes | 0024 |
Services | Multiple therapy disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics therapy) ongoing, one of which must be physical or occupational therapy |
Payment Type | Federal Case Mix Group (CMG) classification + facility level adjustments. Finalized on last discharge claim |
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 IOM 100-4, Chapter 3, 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 IOM 100-2, Chapter 3 | 2021 Part A Deductible - $1,484.00
|
Benefits Exhaust IOM 100-4, Chapter 3, Section 40.2 | Benefits do not exhaust until all 90 days are used in the benefit period and LRDs is Zero
|
Same Day Transfers IOM 100-4, Chapter 3, Section 40.1 | Discharging hospital bills:
Receiving hospital bills claim as usual. Shared diagnosis-related group (DRG) applies |
Provider Liable Days IOM 100-4, Chapter 3, Section 40.1(F) IOM 100-4, Chapter 4, Section 240.1 |
|
Services Provided at Other Facilities During Inpatient Stay | IRF is responsible for all services provided by other facilities during the inpatient stay |
72-hour/24-hour Preadmission Bundling Rule IOM 100-4, Chapter 3, Section 40.3(B) | Not subject to 72-hour rule but are subject to the 24-hour bundling rule for preadmission services to be included on the IRF claim for services provided within your campus |
Same Day Discharge & Readmission IOM 100-4 Chapter 3, Section 40.2.5 | Discharge to acute and returns to IRF before midnight would have all charges included on IRF claim with no same-day transfer claim submitted by acute hospital |
Interrupted Stays/LOA IOM 100-4, Chapter 3, Section 150.9.1.2 | 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
|
Inpatient Care No Longer Needed IOM 100-4, Chapter 3, Section 40.2.2(C) | Date beneficiary notified through Limitation Of Liability, including:
|
Cost Outliers IOM 100-4, Chapter 3, Section 20.1.2, 20.7.4 | Cost outlier payment start day is shown on the claim using occurrence code 47. Provider cannot use LRDs prior to cost outlier day if they run out of full/co-insurance days in that benefit period. If the beneficiary starts the admission with no full or co-insurance days available they can start the day of admission using LRDs without waiting for the cost outlier days. If the beneficiary has some full or coinsurance days but not enough to cover up to the cost outlier day, use occurrence span code 70 to reflect the free/inlier days |
Ancillary Part B Claims | 12x Type Of Bill
|