Thursday, October 5, 2017

Payment for hospital, Therapeutic leave days - revenue code 0185, 0813

HOSPITAL LEAVE DAYS

For Hospital Leave Days, Medicaid will pay to hold a beneficiary’s bed only when the facility’s total available bed occupancy is at 98 percent or more on the day the beneficiary leaves the facility. Facilities at 97.50 percent occupancy may round up to 98 percent. Facilities may not round up 97.45 percent – 97.49 percent to 98 percent. Hospital leave days are limited to a total of 10 days per admission to the hospital for emergency medical treatment. The patient must return to the nursing facility in 10 or fewer days in order for the nursing facility to bill for hospital leave days. When billing, the facility must use:

* Revenue Code 0185; and

* Occurrence Span Code 74, with dates representing the leave days.



THERAPEUTIC LEAVE DAYS

 Therapeutic leave days are limited to a total of 18 days during a 365-day period. When billing, the facility must use:

* Revenue Code 0183; and

* Occurrence Span Code 74, with dates representing leave days.


BILLED FACILITY DAYS

Day of Admission Medicaid reimburses the day of admission if the beneficiary is counted in the facility census (e.g., if they are in the facility at midnight). Day of Discharge Medicaid does not reimburse the day of discharge unless the discharge is due to the resident's death. When billing, the facility must indicate “20” (expired) as the Patient Status Code. A discharge due to death is counted in the facility census.

Hospital Leave Days * If the resident is expected to be in the hospital for 10 days or fewer and dies while in the hospital, the nursing facility may bill for the hospital leave days up to the day before the resident died.

* For Medicaid to pay for hospital leave days, Medicaid must have been paying for the nursing facility stay before the beneficiary was admitted to the hospital.

* If the resident returns to the nursing facility under Medicare coverage, the facility may bill for the hospital leave days if the emergency hospitalization was for ten days or fewer.

* A resident is counted in the facility census if he is in the facility at midnight. If the resident is out of the facility on hospital leave at midnight, that day must be counted as a hospital leave day. If the resident returns to the nursing facility from the hospital, then is readmitted to the hospital for the same condition that he was hospitalized for previously, the 10-day period of Medicaid reimbursed hospital leave days continues if the resident was not counted in the facility census for that day. If, given the circumstances above, the resident was counted in the facility census, a new 10-day period of Medicaid reimbursed hospital leave days may begin.

One-Day Stay A nursing facility is reimbursed for a one-day stay if a Medicaid beneficiary is admitted to the facility and, the same day, is discharged from the facility due to death, return home, or transfer to another institution that is not a Medicaid-enrolled provider. The one-day stay does not apply to a beneficiary admitted to a nursing facility if, later that
day, the beneficiary is discharged and transferred to another nursing facility or an inpatient hospital and, at midnight, the second facility or hospital claims the beneficiary in its daily census.

Outpatient and Emergency Room

A beneficiary who goes to the hospital for outpatient or emergency room services is not discharged from the nursing facility because the beneficiary is not admitted to the inpatient hospital. The beneficiary should be included in the census of the nursing facility, and this day may be billed to Medicaid even if the beneficiary was being treated at midnight in the hospital outpatient or emergency room.

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