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Printed Date: 9/22/2015
Non-teaching IPPS hospitals, IRFs, and long-term care hospitals (LTCH) are required to submit informational only bills to the Fiscal Intermediary for MA beneficiaries. in order for these days to be captured by CMS in the DSH (or LIP for IRF) calculations, non-teaching hospitals are required to submit covered claims with a condition code 04. IPPS teaching hospitals have always been required to submit MA claims with condition codes 04 and 69 in order to be reimbursed for the indirect medical education payment. the IPPS teaching hospitals must continue to bill inpatient claims with condition codes 04 and 69.
This claim was submitted with a condition code 04 only and the discharge date is either prior to 10/1/06 or it has been submitted by an IPPS teaching hospital and the condition code 69 is missing.
Only IRF, LTCH and IPPS hospitals should be billing with 04 condition code to capture the days for the DSH (or LIP for IRF) calculations. If you are not one of these providers, you should not be billing with 04 condition code. Correct and resubmit, if appropriate.
Disproportionate Share Hospital (DSH).
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Last Updated: 12/16/2019