What is interim billing for prospective payment system hospitals?

Answer: For long stay cases, prospective payment system (PPS) hospitals may submit interim bills to Medicare for every 60 days. The provider must submit an adjustment to cancel the original interim bill and re-bill the stay from the admission date through the discharge date.

For example, a beneficiary is inpatient for 130 days. The first claim is a 112 type of bill (TOB) for 60 days. An admission claim is for no less or no more than 60 days. The second claim is a 117 adjustment TOB for no more than 120 days. This adjustment cancels the admission 112 TOB and replaces it. The third claim submitted to report the discharge is also a 117 adjustment TOB for 130 days. A final discharge adjustment will be for no more than 180 days, if needed.

Reference: Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 50 - Adjustment Bills and Section 150.19 - Interim Billing (PDF, 2.22 MB)

 

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