District of Columbia Department of Health Care Finance

Transcription

1 District of Columbia Department of Health Care Finance LTC/ICF MR Provider Follow-up Training Provider Packet Long Term Care Training Presentation LTC/ICF MR Mailing UB04 Claim Form Instructions Training Evaluation Form 1

2 Training Objectives Communicate revised billing changes impacting the LTC/ICF MR provider community Billing Changes 2

3 Billing Changes Bed hold days criteria amended Requirement of patient status and value codes Claims billed monthly Effective with paper claims received on & after December 11 th and electronic claims after December 17 th Billing Changes - Bed Hold Criteria Nursing Facilities Hospital Leave Days Therapeutic Leave Days Combination of Hospital and Therapeutic Days 18 per fiscal year (includes hospitalization and therapeutic days) ICF/MR Facilities 15 per fiscal year 45 per fiscal year 3

4 Billing Changes Patient Status Codes Code Description Discharge to home or self care (routine discharge) Discharged/transferred to another short-term general hospital for inpatient care Discharged/transferred to skilled nursing facility Discharged/transferred to an intermediate care facility Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution Discharged/transferred to home under care of organized home health service organization Left against medical advice or discontinued care Discharged/transferred to home under care of a Home IV provider Admitted as an inpatient to this hospital Expired Still a patient Billing Changes Patient Status Codes Code Description Still a patient Expired at home (Medicare hospice claim only) Expired in a medical facility (e.g., hospital, SNF, ICF, or freestanding hospice) Medicare hospice claims only) Discharged/transferred to federal healthcare facility Discharged to Hospice Home Discharged to Hospice Medical Facility (certified) providing hospice level of care Discharged/transferred within the institution to a hospital-based, Medicareapproved swing bed Discharged/transferred to inpatient rehabilitation facility, including rehabilitation distinct part units of a hospital Discharged/transferred to a Medicare certified long-term care hospital 4

5 Billing Changes Patient Status Codes Code Description Discharged/transferred to a nursing facility certified under Medicaid, but not under Medicare Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital Discharged/transferred to a critical access hospital Discharged/transferred to another type of health care institution not defined in code list Billing Changes Revenue Codes Revenue Code Description Accommodation Days Leave of Absence Leave of Absence Total Charges submitted on the claim Definition Room and board charges Days away from the facility not related to a hospitalization Days away from the facility for an inpatient stay Sum of all line items 5

6 Billing Changes Value Codes Code Description Covered days Non-covered days Co-insurance days (required only for Medicare crossover claims) Lifetime reserve days (required only for Medicare crossover claims) Web Portal UB04 Claim Form 6

7 Web Portal UB04 Patient Status Web Portal UB04 Patient Status 7

8 Web Portal UB04 Value Codes Web Portal UB04 Value Codes 8

9 Web Portal UB04 Revenue Codes Web Portal UB04 Revenue Codes 9

10 UB04 Claim Form (Required) Form Locator 17 Patient Status Enter the patient status code listed in the UB04 claims instructions as of the statement covers through date 10

11 (Required) Form Locator 42 Revenue Code Enter the revenue code listed in the UB04 claim form instructions that identifies the specific accommodation, ancillary service or billing calculation (Required) Form Locator Value Codes Enter the value code listed in the UB04 claim form instructions that identifies the number of covered and non-covered days being billed Note: Enter the appropriate Value Code in the code portion of the field and the number of days in the dollar portion of the Amount section of the field. Enter 00 in the Cents portion of the Amount section of the field. 11

12 Provider Resources Provider Resources Web Portal EDI Companion Guides ACS Call Centers Provider Field Services Provider Inquiry: (202) EDI Technical Support: (866) Bi-Monthly Provider Bulletins Transmittals 12

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