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Issue Number - Name
0022 - Inpatient Psych
Review Type
Automated
Claim Type
Inpatient Hospital, Inpatient Psychiatric Facility
Region and State
RAC 1-4
All States
Date Approved
2017-02-01

Description

Under the Medicare PPS for inpatient psychiatric facilities (IPF), the CMS makes an additional payment to an IPF or a distinct part unit (DPU) for the first day of a beneficiary's stay to account for emergency department costs if the IPF has a qualifying emergency department. However, the CMS does not make this payment if the beneficiary was discharged from the acute care section of a hospital to its own hospital based IPF. In that case, the costs of emergency department services are covered by the Medicare payment that the acute hospital received for the beneficiary's inpatient acute stay. Source of admission code 'D' has been designated for usage when a patient is discharged from an acute hospital to their own psychiatric DPU. This code will prevent the additional payment for the beneficiary's first day of coverage at the DPU. An overpayment occurs when source of admission code 'D' is not billed for these transfer claims.

Affected Codes

  • Claims without Source of Admission Code D

Applicable Policy References

  • Office of Inspector General Report A-01-09-00504 dated May 2010
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 3, Sections 190.6.4 and 190.6.4.1