(Medicare Claims Processing Manual)

-  Short -Stay Outliers  150.9.1.2 -  Interrupted Stays  150.9.1.3 -  Payments for Special Cases  150.9.1.4 -  Payment Policy for Co- Located Providers  150.9.1.5 -  High Cost Outlier Cases  150.10 -  Facility -Level Adjustments  150.10.1 -  Phase- in Implementation  150.11 -  Requirements for Provider Education and Training 150.12 -  Claims Processing and Billing  150.12.1 -  Processing Bills Between October 1, 2002, and the Implementation Date  150.13 -  Billing Requirements Under LTCH PPS  150.14 -  Stays Prior to and Discharge After PPS Implementation Date  150.14.1- Crossover Patients in New LTCHs  150.15 -  System Edits  150.16 -  Billing Ancillary Services Under LTCH PPS  150.17 -  Benefits Exhausted  150.17.1 -  Assumptions for Use in Examples Below  150.17.1.1 -  Example 1: Coinsurance Days < Short Stay Outlier Threshold (30 Day Stay)  150.17.1.2 -  Example 2: Coinsurance Days Greater Than or Equal to Short Stay Outlier Threshold (30 day stay)  150.17.1.3 -  Example 3: Coinsurance Days Greater Than or Equal to Short Stay Outlier Threshold (20 day stay)  150.17.1.4 -  Example 4: Only LTR Days < Short Stay Outlier Threshold (30 day stay)  150.17.1.5 -  Example 5: Only LTR Greater Than or Equal to Short Stay Outlier Threshold (30 day stay)  150.18 -  Provider Interim Payment (PIP)  150.19 -  Interim Billing  150.20 -  Intermediary Benefit Payment Report (IBPR)  150.21 -  Remittance Advices (RAs)  150.22 -  Medicare Summary Notices (MSNs)  150.23 -  LTCH Pricer Software  150.23.1 -  Inputs/Outputs to Pricer  150.24 -  Determining the Cost -to-Charge Ratio  150.25 -  Statewide Average Cost -to-Charge Ratios  150.26 -  Reconciliation  150.27 -  Time Value of Money  150.28 Procedure for Medicare contractors to Perform and Record Outlier Reconciliation Adjustments  160 -  Necessary Changes to Implement Special Add -On Payments for New Technologies  160.1 -  Special Add -On Payments For New Technologies  160.1.1 -  Identifying Claims Eligible for the Add -On Payment for New Technology 160.1.2 -  Remittance Advice Impact  170 -  Billing and Processing Instructions for Religious Nonmedical Health Care Institution (RNHCI) Claims  170.1 -  RNHCI Election Process  170.1.1 -  Requirement for RNHCI Election  170.1.2 -  Revocation of RNHCI Election 170.1.3 -  Completion of the Notice of Election for RNHCI  170.1.4 -  Common Working File (CWF) Processing of Elections, Revocations and Cancelled Elections  170.2 -  Billing Process for RNHCI Services  170.2.1 -  When to Bill for RNHCI Services  170.2.2 -  Required Data Elements on Claims for RNHCI Services  170.3 -  RNHCI Claims Processing By the Medicare Contractor with RNHCI Specialty Workload  170.3.1 -  RNHCI Claims Not Billed to Original Medicare  170.4 -  Informing Beneficiaries of the Results of RNHCI Claims Processing 180 -  Processing Claims For Beneficiaries with RNHCI Elections by Contractors without RNHCI Specialty Workloads  180.1 -  Recording Determinations of Excepted/Nonexcepted Care on Claim Records  180.2 -  Informing Beneficiaries of the Results of Excepted/Nonexcepted Care Determinations by the Non-specialty Contractor  190 -  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)  190.1 -  Background  190.2 -  Statutory Requirements  190.3 -  Affected Medicare Providers  190.4 -  Federal Per Diem Base Rate  190.4.1 -  Standardization Factor  190.4.2 -  Budget Neutrality 190.4.2.1 -  Budget Neutrality Components  190.4.3 -  Annual Update  190.4.4 -  Calculating the Federal Payment Rate  190.5 -  Patient -Level Adjustments  190.5.1 -  Diagnosis -Related Groups (DRGs) Adjustments  190.5.2 -  Application of Code First  190.5.3 -  Comorbidity Adjustments  190.5.4 -  Age Adjustments  190.5.5 -  Variable Per Diem Adjustments  190.6 -  Facility -Level Adjustments  190.6.1 -  Wage Index  190.6.2 -  Rural Location Adjustment  190.6.3 -  Teaching Status Adjustment  190.6.3.1 -  Full-Time Equivalent (FTE) Resident Cap  190.6.3.2 -  Reconciliation of Teaching Adjustment on Cost Report  190.6.4 -  Emergency Department (ED) Adjustment  190.6.4.1 -  Source of Admission for IPF PPS Claims for Payment of ED Adjustment  190.6.5 -  Cost -of- Living Adjustment (COLA) for Alaska and Hawaii  190.7 -  Other Payment Policies  190.7.1 -  Interrupted Stays  190.7.2 -  Outlier Policy  190.7.2.1 -  How to Calculate Outlier Payments  190.7.2.2 -  Determining the Cost -to-Charge Ratio  190.7.2.3 Outlier Reconciliation  190.7.2.4. Time Value of Money 190.7.2.5 -  Procedures for Medicare Contractors to Perform and Record Outlier Reconciliation Adjustments  190.7.3 -  Electroconvulsive Therapy (ECT) Payment  190.7.4 -  Stop Loss Provision (Transition Period Only)  190.8 -  Transition (Phase -In Implementation)  190.8.1 -  Implementation Date for Provider  190.9 -  Definition of New IPF Providers Versus TEFRA Providers  190.9.1 -  New Providers Defined  190.10 -  Claims Processing Requirements Under IPF PPS  190.10.1 -  General Rules  190.10.2 -  Billing Period  190.10.3 -  Patient Status Coding  190.10.4 -  Reporting ECT Treatments  190.10.5 -  Outpatient Services Treated as Inpatient Services  190.10.6 -  Patient is a Member of a Medicare Advantage Organization for Only a Portion of a Billing Period  190.10.7 - Billing for Interrupted Stays  190.10.8 - Grace Days  190.10.9 - Billing Stays Prior to and Discharge After PPS Implementation Date  190.10.10 - Billing Ancillary Services Under IPF PPS  190.10.11 - Covered Costs Not Included in IPF PPS Amount  190.10.12 - Same Day Transfer Claims  190.10.13 - Remittance Advice - Reserved  190.10.14 - Medicare Summary Notices and Explanation of Medicare Benefits  190.11 - Benefit Application and Limits -190 Days 190.12 - Beneficiary Liability  190.12.1 - Benefits Exhaust  190.13 - Periodic Interim Payments (PIP)  190.14 - Intermediary Benefit Payment Report (IBPR)  190.15 - Monitoring Implementation of IPF PPS Through Pulse  190.16 - IPF PPS System Edits  190.17 - IPF PPS PRICER Software  190.17.1 - Inputs/Outputs to PRICER  200 - Electronic Health Record (EHR) Incentive Payments  200.1 - Payment Calculation  200.2 - Submission of Informational Only Bills for Maryland Waiver Hospitals and Critical Access Hospitals (CAHs)