Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
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.
Explanation and Suggestions:
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 12/27/2018