12505

FISS Narrative
The average daily rate on the bill must be equal to or greater than the coinsurance rate calculated for each calendar year. The total covered charges divided by the number of utilization days must equal or exceed the coinsurance rate unless an Occurrence Span Code 77 reflects provider liability. Please correct and resubmit/rekey. Hardcopy submitters resubmit RTP report with corrections.

Guidelines and suggestions:
The average daily rate on a skilled nursing facility (SNF) or inpatient claim must be equal to or greater than the calculated coinsurance rate for each calendar year, unless an Occurrence Span Code 77 is present on the claim.

The average daily rate is computed as:
Total covered charges less non-covered charges divided by the number of covered days.

The coinsurance rate is computed as:
The Value Code amount divided by the number of coinsurance days.

Example: Value Code 09 amount is divided by the number of first year coinsurance days. Value Code 11 amount is divided by the number of second year coinsurance days.