Reporting Accommodations on the Claim

40.6.3 - Reporting Accommodations on the Claim (Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of ICD-10 ASC X12: 09-16-14) See the Medicare Benefit Policy Manual, Chapter 1, “Inpatient Hospital Services,” for an explanation of the rules when other than semi-private accommodations are furnished that apply to SNFs as well as hospitals. The type of accommodation furnished at the time of the SNF census-taking hour determines the applicable revenue code. Where a patient is admitted with the expectation that he will remain overnight, but on the same day is discharged, dies, or is transferred prior to the census, the revenue code is determined by the type of accommodation furnished at the time of the patient’s discharge, death, or transfer. Payment is based on the PPS rate, not on accommodation levels. See §40.6.1 where the patient requests more expensive accommodations or patient convenience items. The determination of charges does not affect the determination of inpatient utilization days or when a patient may be considered an inpatient for Medicare purposes as outlined in the Medicare Benefit Policy Manual, Chapter 8, “Coverage of Extended Care (SNF) Services Under Hospital Insurance,” §50 and §60.2. Refer to the Medicare Claims Processing Manual, Chapter 25 for further information about billing. SNFs show total charges for accommodation for the entire billing period and charges for any noncovered days in noncovered charges.) The accommodation days do not include the day of death or discharge, even where the discharge was late. However, where the SNF customarily makes an extra charge for a late discharge, they include this amount in total charges with the appropriate accommodation revenue code. The day of discharge is not included in Covered Days even though an extra charge is included. Where the late discharge was for the patient’s convenience and not for any medical necessity, SNFs enter the charge for late discharge as a noncovered charge. Where the late discharge is for a medical reason, the charge is covered. (See the Medicare Benefit Policy Manual, Chapter 8, “Coverage of Extended Care (SNF) Services Under Hospital Insurance,” §60.3.) The charges for accommodations reflect only the total charges for general routine services as defined in §2202.6 and §2203.1 of the Medicare Provider Reimbursement Manual. All charges, which are charged to every patient for every patient day, are included in the routine accommodation charge. SNFs bill ancillary charges for day of discharge, death or the day on which a leave of absence begins, under the proper revenue code. Where the patient is discharged on his first day of entitlement or the first day of the SNF participation in the Medicare program, they submit a bill with no accommodation charge, but with ancillary charges. Where some of the days cannot be paid under Part A because benefits were exhausted before discharge, death, or the day on which a leave of absence began, SNFs show the charges for days after benefits where exhausted under noncovered charges, and enter the appropriate occurrence code, e.g., A3, and the date benefits are exhausted. See the Medicare Claims Processing Manual, Chapter 7, “SNF Part B Billing,” §10, for billing under Part B in such circumstances.