(Medicare Claims Processing Manual)

 For subsequent interim bills, bill type 117 with a patient status of 30 (still patient); or   For subsequent discharge bills, bill type 117 with a patient status other than 30. (See Chapter 25 for a list of valid patient discharge status codes)   All inpatient providers must submit bills when any of the following occur, regardless of the date of the prior bill (if any):    Benefits are exhausted;   The beneficiary ceases to need a hospital level of care (all hospitals);   The beneficiary falls below a skilled level of care (SNFs and hospital swing beds); or   The beneficiary is discharged.   Effective December 3, 2007, when a beneficiarys Medicare benefits exhaust in an IPF or an LTCH, the hospital is allowed to submit a no pay bill (TOB 110) with a patient status code 30 in 60 day increments until discharge.  They no longer have to continual ly adjust bills until physical discharge or death.  The last bill shall contain a discharge patient status code.   These instructions for hospitals and SNFs apply to all providers, including those receiving Periodic Interim Payments (PIP).  Providers should continue to submit no- pay bills until discharge.   NOTE :  For stays that necessitate the reporting of more than ten OSCs (i.e., more OSCs than the claim formats allow), Long Term Care Hospitals, Inpatient Psychiatric Facilities, and Inpatient Rehabilitation Facilities shall refer to instructions provided in Chapter 32, section 74.3 of this manual.  50.2.2 - Frequency of Billing for Providers Submitting Institutional Claims with Outpatient Services (Rev. 2092, Issued: 11- 12-10, Effective: 04 -01-11, Implementation: 04- 04-11)  Repetitive Part B services furnished to a single individual by providers that bill institutional claims shall be billed monthly (or at the conclusion of treatment).  The instructions in this subsection also apply to hospice services billed under Part A, though they do not apply to home health services.  Consolidating repetitive services into a single monthly claim reduces CMS processing costs for relatively small claims and in instances where bills are held for monthly review.  Services repeated over a span of time and billed with the following revenue codes are defined as repetitive services:   Type of Service  Revenue Code(s)  DME Rental  0290  0299  Respiratory Therapy  0410, 0412, 0419  Physical Therapy  0420  0429  Occupational Therapy  0430  0439  Speech -Language Pathology  0440  0449  Skilled Nursing  0550  0559  Kidney Dialysis Treatments  0820  0859  Cardiac Rehabilitation Services  0482, 0943  Pulmonary Rehabilitation Services  0948   Hospitals in Maryland that are under the jurisdiction of the Health Services Cost Review Commission are subject to monthly billing cycles.   Where there is an inpatient stay, or outpatient surgery, or outpatient hospital services subject to OPPS, during a period of repetitive outpatient services, one bill for repetitive services shall nonetheless be submitted for the entire month as long as the  provider uses an occurrence span code 74 on the monthly repetitive bill to encompass the inpatient stay, day of outpatient surgery, or outpatient hospital services subject to OPPS.  CWF and shared systems must read occurrence span 74 and recognize the ben eficiary cannot receive non -repetitive services while receiving repetitive services, and consequently, is on leave of absence from the repetitive services.  This permits submitting a single, monthly bill for repetitive services and simplifies Contractor re view of these bills.  The following is an illustration explaining this scenario:    Any items and/or services in support of the repetitive service shall be reported on the same claim even if the revenue code(s) reported with those supported services are not on the repetitive revenue code list ( NOTE:   Supporting items and/or services are those in which are needed specifically in the performance of the repetitive service.  Examples may include disposable supplies, drugs or equipment used to furnish the repetitive service).  However, to facilitate APC recalibration, do not report unrelated one- time, non- repetitive services that have the same date of service as a repetitive service (even if both the non -repetitive service and the repetitive service are paid under OPPS).  If a n on-repetitive OPPS service is provided on the same date as a repetitive service, report the non -repetitive OPPS services, along with any packaged and/or services related to the non-repetitive OPPS service, on a separate OPPS claim.  For example, if a chemo therapy drug is administered on a day a repetitive service is also rendered, report the chemotherapy drug, its administration, its related supplies, etcetera, on a separate claim from the monthly repetitive services claim.  Similarly, as shown below in the  illustration, Example: Monthly Repetitive Billing Procedure, a physical therapy treatment (which is a repetitive service because it is reported under a revenue code on the repetitive service list) is administered on the same day an outpatient consultation and a CT scan are Occurrence Span  Code   |     From    |    Through           74           7/12/05       7/16//05 MONTHLY REPETITIVE BILL  INPATIENT BILL  Statement Covers Period            From     |     Through            7/12/05        7/16/05  Leave of Absence Carve -Out Example  Statement Covers Period  From     |    Through                  7/01/05        7/31/05 Line Item Service Date  1) 7/04/05 2) 7/11/05 3) 7/18/05 4) 7/25/05   furnished, report the physical therapy service on the claim with the other physical therapy services provided during the applicable month.  Report the visit for the consultation and the CT scan on a separate claim.    Revenue codes usually reported for chemotherapy and radiation therapy are not on the list of revenue codes that may only be billed monthly.  Therefore, hospitals may bill chemotherapy or radiation therapy sessions on separate claims for each date of servic e.  However, because it is common for these services to be furnished in multiple encounters that occur over several weeks or over the course of a month, hospitals have the option of reporting charges for those recurring services on a single bill, as though they were repetitive services.  If hospitals elect to report charges for recurring, non- repetitive services (such as chemotherapy or radiation therapy) on a single bill, they must also report all charges for services and supplies associated with the recur ring service on the same bill.  The services may all be reported on the same claim or billed separately by date of service as illustrated below:   Example: Monthly Repetitive Billing Procedure  1.Physical Therapy  2.Outpatient Consultation  3.CT Scan  Monthly Repetitive Bill 7/4/05     7/11/05 7/18/05 7/18/05  7/18/05 Outpatient Bill  Line Item Service Date  Line Item Service Date    Indian Health Service Hospitals, Maryland hospitals, as well as hospitals located in Saipan, Guam, American Samoa, and the Virgin Islands are not subject to OPPS.  In addition, hospitals that furnish only inpatient Part B services are also exempt from OPPS. Bills for ambulatory surgery in these hospitals shall contain on a single bill all services provided on the same day as the surgery except kidney dialysis services, which are billed on a 72X bill type.  Non- ASC services furnished on a day other than the day of surgery shall not be included on the outpatient surgical bill.  See Chapter 16 for clinical diagnostic lab services paid under the fee schedule when included with outpatient bills for other services.  Contractors periodically review bills from providers known to be furnishing repetitive services to determine if they are billing more frequently than proper.  Techniques that may be used are:    Sample review of bills to determine if most are for a monthly period (by using from and thru dates or number of services).  This may be done manually or electronically. Contractors may rely on informal communications from their medical review staff, and   Contractors should educate providers that bill improperly. Contractors shall:    Return bills with an explanation and request proper billing to providers that continue to bill improperly.   Not return bills where the treatment plan is completed indicating discontinued services because the beneficiary dies or moves.   7/1/05   7/8/05       7/22/05    7/29/05  Billing Procedures for Recurring Services Not Defined as Repetitive  1) Submit multiple bills for each date of service (include only the recurring service and its related services):   OR 2) Submit a monthly bill for all line item dates of service (for the entire months recurring services with all services related to the recurring services):   7/1/05   7/8/05  7/22/05  7/29/05  50.2.3 - Submitting Bills In Sequence for a Continuous Inpatient Stay or Course of Treatment  (Rev. 2578, Issued: 11- 01-12, Effective: 01-01-13, Implementation: 04-01-13)  When a patient remains an inpatient of a SNF, TEFRA hospital or unit, swing-bed, or hospice beyond the end of a calendar month, providers must submit a bill for each calendar month. (See 50.2.1 for frequency of billing for inpatient services.) Claims for the beneficiary are to be submitted in service date sequence. The shared system must edit to prevent acceptance of a continuing stay claim or course of treatment claim until the prior bill has been processed. If the prior bill is not in history, the incomi ng bill will be returned to the provider with the appropriate error message.  When an out- of-sequence claim for a continuous stay or outpatient course of treatment is received, FIs will search the claims history for the prior bill. They do not suspend the out-of-sequence bill for manual review, but perform a history search for an adjudicated claim. For bills other than hospice bills, if the prior bill is not in the finalized claims history, they return to the provider the incoming bill with an error message requesting the prior bill be submitted first, if not already submitted. The r eturned bill may only be resubmitted after the provider receives notice of the adjudication of the prior bill. A typical error message would be as follows:   Bills for a continuous stay or admission or for a continuous course of treatment must be submitted in the same sequence in which the services are furnished. If you have not already done so, please submit the prior bill. Then, resubmit this bill after you r eceive the remittance advice for the prior bill.   For a partial hospitalization program claim to determine out-of- sequence claim submission for the outpatient course of treatment, providers must utilize the correct frequency digit in the type of bill as follows:  If the from and through (FL6) dates on the claim being submitted include the dates for all services of the course of treatment, then the frequency digit in the type of bill will be a 1 [Admit through Discharge Claim]  (i.e., 131, 761, or 851).  The f inal Patient Discharge Status code (FL 17) will be entered.   If the from and through dates (FL6) on the claim being submitted include the dates for services at the start of the course of treatment (first of a series of bills) and additional services are expected to be submitted on a subsequent bill, then the frequency digit in the type of bill will be a 2 [Interim  First Claim] (i.e., 132, 762, or 852).  The Patient Discharge Status code (FL 17) will be a 30.  If the from and through dates (FL6) on the claim being submitted include the dates for services at the neither at the start or at the completion of the course of treatment and additional services are expected to be submitted on a subsequent bill, then the frequency digit in the type of bill will be a 3 [Interim  Continuing Claim] (i.e., 133, 763, or 853).  The Patient Discharge Status code (FL 17) will be a 30.  If the from and through dates (FL6) on the claim being submitted include the dates for services at the completion of the course of treatment (last of a series of bills) and no additional services are expected to be submitted on a subsequent bill, then the frequency digit in the type of bill will be a 4 [Interim  Last Claim] (i.e., 134, 764, or 854).  The final Patient Discharge Status code (FL 17) will be entered.   Leave of Absence Carve- Out process from 50.2.2 applies.  Providers may submit Interim Bills daily, weekly, or monthly as long as the claims are submitted with the correct frequency code in the type of bill and sequentially.