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June 25, 2018

Part A Inpatient Date of Service Reporting and Split Billing

This is a reminder of the correct date of service to submit on your claim.

Inpatient Date of Service Reporting

For all inpatient claims (including acute general hospital, psychiatric hospital, rehabilitation hospital, long-term care hospital, and skilled nursing facility), the date(s) of service is reported in form locator (FL) 6, Statement Covers Period, of the UB-04 claim form or its electronic equivalent.

Each inpatient claim contains the Statement Covers Period ('From' and 'Through' dates) to identify the span of service dates included in a particular bill.

  • The 'From' date is the earliest date of service on the bill.
  • The 'Through' date equals the date the patient was discharged from the facility or remains a patient of the facility (discharge status code 30).

Note: Use the benefits exhaust date to substitute for the discharge date on both Inpatient Psychiatric Facility and Long Term Care Hospital (LTCH) PPS claims when present.

The Admission Date (FL 12) is the date the patient was admitted as an inpatient to the facility (or indicates the start of care date for home health and hospice). It is reported on all inpatient claims regardless of whether it is an initial, interim or final bill. The admission date and ‘From' dates are not required to match.

Inpatient Split Billing

There are times when an inpatient admission may cross over the provider's fiscal year end, the federal fiscal year end or calendar year end.

The fiscal year is any 12 consecutive months chosen to be the official accounting period by a business or organization. A fiscal year end can be the end of any quarter – March 31, June 30, September 30, or December 31.

The federal fiscal year is the 12-month period ending on September 30 of that year, having begun October 1 of the previous calendar year.

A calendar year is the one-year period that begins on January 1 and ends on December 31.

The following chart provides guidance on when to split a claim by provider specialty or by federal fiscal year or calendar year in these situations.

Provider Type Provider Fiscal Year End Federal Fiscal Year End Calendar Year End
Inpatient PPS Provider (Acute, LTCH, IHS, IRF, Psychiatric Unit of a Hospital) No No No
Maryland Waiver Yes No No
Critical Access Hospital Yes No No
Cancer and Children's Hospitals Yes No No
Periodic Interim Payment (PIP) Hospital Yes No No
State Certified Inpatient Psych Facility Yes No No
Skilled Nursing Facility/ Swing Bed (please note, no pay bills may span both provider and federal fiscal year) Yes Yes No
CAH Swing Bed Yes No Yes

Non-PPS Inpatient Split Billing Examples

Your fiscal year end is 6/30/17. The patient was admitted on 6/28/17 and was discharged home on 7/3/17. Submit the claims as follows:

1st claim (submitted first)

  • Type of bill = 112 (first in a series of claims)
  • Admission Date = 6/28/2017
  • From Date and Through Date= 6/28/2017 through 6/30/2017
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 114 (discharge bill)
  • Admission Date = 6/28/2017
  • From Date and Through Date = 7/1/2017 through 7/3/2017
  • Patient Status = 01 (discharged home)

Your fiscal year end is 6/30/2017. The patient was admitted on 6/25/2017 and discharged home on 7/1/2017. The claims should be submitted as follows:

1st claim (submitted first)

  • Type of bill = 112 (first in a series of claims)
  • Admission Date = 6/25/2017
  • From Date and Through Date= 6/25/2017 through 6/30/2017
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 114 (discharge bill)
  • Admission Date = 6/25/2017
  • From Date and Through Date = 7/1/2017 through 7/1/2017
  • '0' covered days
  • Patient Status = 01 (discharged home)

Note: All ancillary charges that occurred on the date of discharge are included on this claim.

Critical Access Hospital Split Billing Example

Your fiscal year end is 6/30/2017. The patient was admitted on 6/25/2017 and discharged home on 7/1/2017. The claims should be submitted as follows:

1st claim (submitted first)

  • Type of bill = 112 (first in a series of claims)
  • Admission Date = 6/25/2017
  • From Date and Through Date= 6/25/2017 through 6/30/2017
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 110 (non-payment)
  • Admission Date = 6/25/2017
  • From Date and Through Date = 7/1/2017 through 7/1/2017
  • Condition Code = 21
  • Room and Board: $0.01
  • Patient Status = 01 (discharged home)
  • '0' covered days
  • Ancillary Charges may not be billed

Note: Date of discharge not counted as a day, thus the reason for submitting a no-pay bill.

Swing Bed Inpatient Split Billing Example

Your fiscal year end is 6/30/2017. The patient was admitted on 6/25/2017 and discharged home on 7/1/2017. The claims should be submitted as follows:

1st claim (submitted first)

  • Type of bill = 182 (first in a series of claims)
  • Admission Date = 6/25/2017
  • From Date and Through Date= 6/25/2017 through 6/30/2017
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 184 (discharge bill)
  • Admission Date = 6/25/2017
  • From Date and Through Date = 7/1/2017 through 7/1/2017
  • Condition Code = 21
  • Room and Board: $0.01
  • Patient Status = 01 (discharged home)
  • '0' covered days
  • Ancillary Charges may not be billed

References

This document was developed through the A/B Medicare Administrative Contractor Provider Outreach & Education Collaboration Team. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and will assist the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.

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