What is Medicare condition code 47?
Occurrence code 47 — indicates the first day the inpatient cost outlier threshold is reached or the date after the DRG cutoff date. Used for leave of absence or for repetitive part B services to show a period of inpatient hospital care or outpatient surgery during the billing period.
What does value code 47 mean?
Liability Insurance
47. Any Liability Insurance. Requires OC 02 with date of accident/injury. Primary Payer Code = L. If filing for a Conditional Payment, report with Occurrence Code 24.
What are ub04 condition codes?
Condition codes refer to specific form locators in the UB-04 form that demand to describe the conditions applicable to the billing period. It is important to note that condition codes are situational. These codes should be entered in an alphanumeric sequence.
What is a condition code?
Currently, Condition Codes are designed to allow the collection of information related to the patient, particular services, service venue and billing parameters which impact the processing of an Institutional claim. These codes are integral to the institutional claim, both the paper UB and the electronic 837I.
What is TOB 34X?
The HHA submits claims with type of bill (TOB) 34X to bill for certain Part B “medical. and other health services” when there is no home health plan of care. Specifically the.
What is OTAF segment?
This is the amount the provider agreed to accept from the primary payer when the amount is less than the charges but higher than the payment amount; then a Medicare secondary payment is due to the provider.
What is UB 04 condition?
What are UB04 Condition Codes? This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. The provider enters the corresponding code (in numerical order) to describe any conditions or events that apply to the billing period.
What is DDE Fiss?
The Fiscal Intermediary Shared System (FISS) is the processing system designated by the Centers for Medicare & Medicaid (CMS) to be used for Medicare Part A claims and Part B facility claims. DDE is a real-time FISS application giving providers interactive access for inquiries, claims entry and correction purposes.
Is the occurrence Code 47 equal to the dates of occurrence?
Occurrence code 47 cannot be equal to or during the dates of occurrence span code 74 or 76. Occurrence span code 74 — the from/through dates for a period at a non-covered level of care in an otherwise covered stay, excluding any period reported with occurrence span codes 76, 77, or 79. Codes 76 and 77 apply to most non-covered care.
When is it appropriate to use occurrence code 77?
Codes 76 and 77 apply to most non-covered care. Used for leave of absence or for repetitive part B services to show a period of inpatient hospital care or outpatient surgery during the billing period. Also used for home health association (HHA) or hospice services billed under part A, but not valid for HHA under prospective payment system (PPS).
When to use cost outlier occurrence Code 47?
For Medicare purposes, a beneficiary must have regular coinsurance and/or lifetime reserve days available beginning on this date to allow coverage of additional daily charges for the purpose of making cost outlier payments. Occurrence code 47 cannot be equal to or during the dates of occurrence span code 74 or 76.
When to submit OC 47 for non-utilization?
Submit the date of the first full day of outlier status (the day after the day that covered charges reach the cost outlier threshold) on the bill using OC 47. Any non-utilization days after the beneficiary exhausts coinsurance or LTR days before the OC 47 date will be coded by the Fiscal Intermediary Shared System using OSC 70.