Benefits Exhaust

90 - Benefits Exhaust (Rev. 253, Issued: 12- 14-18, Effective: 01-16-19, Implementation: 01- 16-19) Effective December 3, 2007, for payment purposes, an IPF discharge occurs when benefits exhaust, and the benefits exhaust date will substitute for the discharge date. The claim will be paid either on the discharge date if the benefits are available or on benefit exhaust date if the discharge is after the benefits exhaust date. When the services actually are provided, the PRICER version used to price claims for the time will be used. No pay/110 TOBs are allowed instead of continually adjusting the claims (117 TOB) until actual discharge occurs once benefits exhaust. Under the Tax Equity and Fiscal Responsibility Act (TEFRA), the Provider Statistical and Reimbursement (PS&R) report used the benefits exhaust date as the discharge date. This changed when the IPF PPS was implemented, and the 'actual' discharge date was used. The days stay with the year they occurred, making it easier for the PS&R report (especially during the blend period) to settle the cost report. This means that: 1. Claims will be settled on the appropriate cost report; 2. The appropriate PPS-TEFRA blend percentage will be paid; 3. Patients with long lengths of stay will be counted on the correct PS&R report; and 4. The PRICER version used will be the one in effect at the time the services were provided.