Billing issues FAQs
Why is my claim overlapping the other facility when the dates do not fall within their dates of service? Should the treatment encounter notes for therapy services capture total timed code treatment minutes and total treatment time? When billing an inpatient Medicare Part B only claim (12X or 22X type of bill code), should a hospital bill for accommodation charges?Q: Why is my claim overlapping another facility, when the dates do not fall within their dates of service?
A: If your patient status code is incorrect, it can indicate a patient is still in your facility when, in fact, they were discharged and admitted to another facility.
Use a status code to show the patient has been discharged from your facility to another facility.
• Example: Patient Status Code 03 = Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care. Medicare indicates the patient is discharged/transferred to a Medicare certified SNF.
(Last Modified 09/27/07)
Source: CMS IOM Pub 100-04 – Medicare Claims Processing Manual, Chapter 25, Sections 75 & 75.2
Q: Should the treatment encounter notes for therapy services capture total timed code treatment minutes and total treatment time?
A: Yes. It is a requirement that the total timed code treatment minutes and total treatment time is captured in the treatment encounter notes. However, the amount of time for each specific intervention/modality provided to the patient is not required, as it is indicated in the billing. The billing and the total timed code treatment minutes must be consistent and, in addition, the identification of each specific intervention/modality provided and billed, for both timed and untimed codes, needs to be recorded.
Example:
18 minutes of therapeutic exercise (97110)
13 minutes of manual therapy (97140)
10 minutes of gait training (97116)
8 minutes of ultrasound (97035)
13 minutes of manual therapy (97140)
10 minutes of gait training (97116)
8 minutes of ultrasound (97035)
Total treatment time: 49 minutes.
How to bill for the above example:
Appropriate billing is for 3 units. Bill the procedures you spent the most time providing. Bill 1 unit each of 97110, 97116, and 97140. You are unable to bill for the ultrasound, because the total time of time units which can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless of how many services were performed). You should still document the ultrasound in the treatment notes.
(Last Modified 2/27/08)
Source: CMS Internet Only Manual (IOM) Pub. 100-04, Chapter 5, Section 20.2
Q: When billing an inpatient Medicare Part B only claim (12X or 22X type of bill code), should a hospital bill for accommodation charges?
A: On an ancillary bill (12X and 22X), a provider should not submit accommodation charges. Inpatient ancillary services may be paid under Medicare Part B when the level of care becomes non-covered under Medicare Part A or when the Part A benefits are exhausted.
• Medicare Part B inpatient ancillary services include radiology, pathology, electrocardiology, electroencephalography, physical therapy, speech pathology, renal dialysis, and medical supplies (prosthetic devices, braces, and splints).
(Last Modified 9/27/07)
Source: CMS IOM Pub 100-02 – Medicare Benefits Policy Manual, Chapter 6, Section 10
