ckeeney
Guru
I am relatively new to the billing side of behavioral health. The scenario is as follows:
Patient had an extended inpatient stay with sufficient psych days. Medicare and Medicaid payers.
Claim denied for no use of lifetime reserve days.
Patient was not notified of the need for lifetime reserve days and has been discharged to a state hospital facility.
Because patient has Medicaid as secondary payer must we bill the lifetime reserve days?
The claim would have (example)
Value code 80 - 115 days
Value code 82 - 30 (co-insurance days)
Value code 83 - 25 (lifetime reserve days)
Is this correct?
What about the requirement to notify patient about the option to exclude lifetime reserve days? Is this overridden by Medicaid secondary payer?
I find the CMS manual somewhat confusing and contradictory.
Please help. Thank you.
Patient had an extended inpatient stay with sufficient psych days. Medicare and Medicaid payers.
Claim denied for no use of lifetime reserve days.
Patient was not notified of the need for lifetime reserve days and has been discharged to a state hospital facility.
Because patient has Medicaid as secondary payer must we bill the lifetime reserve days?
The claim would have (example)
Value code 80 - 115 days
Value code 82 - 30 (co-insurance days)
Value code 83 - 25 (lifetime reserve days)
Is this correct?
What about the requirement to notify patient about the option to exclude lifetime reserve days? Is this overridden by Medicaid secondary payer?
I find the CMS manual somewhat confusing and contradictory.
Please help. Thank you.