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Printed Date: 9/22/2015
For discharges for non-teaching Inpatient Prospective Payment System (IPPS) hospitals, inpatient rehabilitation facilities (IRFs) and long term care hospitals (LTCHs) are required to submit informational only bills to Palmetto GBA for MA beneficiaries. In order for these days to be captured by CMS in the disproportionate share hospital (DSH) (or low income patient (LIP) payments for IRF) calculations, non-teaching hospitals are required to submit covered claims with 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. IPPS teaching hospitals must continue to bill inpatient claims with condition codes 04 and 69. This reason code signifies that the claim was submitted with condition code 04 only and the discharge date has been submitted by an IPPS teaching hospital, and condition code 69 is missing.
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Last Updated: 12/27/2018