Inpatient Services

40.1.1- Inpatient Services (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) If payment by the primary payer for Medicare covered services (as determined by the formula in section 40.2.2 below) equals or exceeds the provider's charge for those services or the current Medicare interim payment amount (without regard to deductible or coinsurance), or the provider accepts or is obligated to accept the primary payer payment as payment in full and receives at least this amount, no payment is due from Medicare, and no utilization is charged to the beneficiary. However, the provider submits a no-payment bill for determining the benefit period. In addition, primary payer payments are used to satisfy unmet deductibles. The A/B MACs (Part A) shall process the bill in accordance with Pub. 100-5, Chapter 5 and as follows: • The provider completes the total and noncovered charges columns as if there had been no other payment; • Where blood is involved, the provider completes the blood items. (This data is for the beneficiary's utilization records only and is not to be used for the Provider Statistical & Reimbursement [PS&R] Report); • The provider does not complete the coinsurance amount (no days are charged). However, inpatient deductible and total deductions are completed when applicable. (This data is for the beneficiary's utilization records only and is not to be used for the PS&R Report.); • The provider shows total covered and noncovered days in the usual manner. The A/B MACs (Part A) count days paid by the primary payer as covered days; • The provider enters the appropriate value code to identify the primary payer; • The provider enters the amount paid by the primary payer in the Value Amount field; • The provider enters condition code 77 in the condition code field when it receives an amount it is obligated to accept from the primary payer as payment in full; • The A/B MACs (Part A) do not complete the nonpayment code; • The A/B MACs (Part A) enter the additional MSP data elements that may apply to the bill based on the applicable MSP provision according to section 50 below.