ckeeney
Guru
POS 51 - Inpatient Psychiatric Facility.
The client has been enrolled in Medicare for ~10 years.
The client was inpatient for a total of 360 days.
Client had Part C coverage for 48 days and then coverage was Part A for the remainder of the stay.
The Part C plan was billed for the 48 days and paid in accordance with their prior authorization.
In the 150 days prior to Part A coverage starting again, the client had a total of 86 days in our unit and another psychiatric hospital. This includes the 48 days billed to Part C for the current stay, 20 days at the other hospital and the remaining days were billed to Part C for a prior stay at our facility.
If I am reading the IOM correctly, we would only be able to bill for the remaining 64 days of the benefit period 150 days prior to Part A coverage starting again. Is this correct? Then there would be 60 regular days and 4 co-insurance days I could bill as covered days.
If I am not reading the IOM correctly, do I bill the full 150 days allowable for 60 regular days, 30 co-insurance days, 60 LTR days?
Do I add Occurrence Code A2 - start date for current Part A coverage?
Do I need Occurrence Code A3 - benefit exhaust date?
Occurrence Span 77 - with dates for the Value Code 81 - non-covered days
Client has 190 days of lifetime psychiatric inpatient benefit available.
Any thoughts on this would be greatly appreciated!
The client has been enrolled in Medicare for ~10 years.
The client was inpatient for a total of 360 days.
Client had Part C coverage for 48 days and then coverage was Part A for the remainder of the stay.
The Part C plan was billed for the 48 days and paid in accordance with their prior authorization.
In the 150 days prior to Part A coverage starting again, the client had a total of 86 days in our unit and another psychiatric hospital. This includes the 48 days billed to Part C for the current stay, 20 days at the other hospital and the remaining days were billed to Part C for a prior stay at our facility.
If I am reading the IOM correctly, we would only be able to bill for the remaining 64 days of the benefit period 150 days prior to Part A coverage starting again. Is this correct? Then there would be 60 regular days and 4 co-insurance days I could bill as covered days.
If I am not reading the IOM correctly, do I bill the full 150 days allowable for 60 regular days, 30 co-insurance days, 60 LTR days?
Do I add Occurrence Code A2 - start date for current Part A coverage?
Do I need Occurrence Code A3 - benefit exhaust date?
Occurrence Span 77 - with dates for the Value Code 81 - non-covered days
Client has 190 days of lifetime psychiatric inpatient benefit available.
Any thoughts on this would be greatly appreciated!