Date of Service Reporting
This is a reminder of when to report the date of service on your claim.

Inpatient Hospital
For all inpatient claims (including acute general hospital, psychiatric hospital, rehabilitation hospital, long-term care hospital), the date(s) of service is reported in form locator (FL) 6, Statement Covers Period, of the UB-04 claim form or its electronic equivalent.

Each inpatient claim contains the Statement Covers Period ("from" and "through" dates) to identify the span of service dates included in a particular bill. The "from" date is the earliest date of service on the bill. The "through" date equals the date the patient was discharged from the facility.

Note: Both Long-Term Care Hospital (LTCH) and Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) claims will use the benefits exhaust date to substitute for the discharge date claims when present.

The Admission Date (FL 12) is the date the patient was admitted as an inpatient to the facility (or indicates the start of care date for home health and hospice). It is reported on all inpatient claims regardless of whether it is an initial, interim or final bill.

Inpatient Hospital Split Billing
There are times when an inpatient admission may cross over the provider’s fiscal year end, the federal fiscal year end or calendar year end.

The fiscal year is any 12 consecutive months chosen to be the official accounting period by a business or organization. A fiscal year end can be the end of any quarter — March 31, June 30, September 30, or December 31.

The federal fiscal year is the 12-month period ending on September 30 of that year, having begun on October 1 of the previous calendar year.

A calendar year is the one-year period that begins on January 1 and ends on December 31.

The following chart provides guidance on when to split a claim by provider specialty or by year type on billing in these situations

Provider Type
Provider’s Fiscal Year End
Federal Fiscal Year End
Calendar Year End
Inpatient PPS Provider (Acute, LTCH, IHS, IRF, Psychiatric Unit of a Hospital)
No
No
No
Maryland Waiver
Yes
No
No
Critical Access Hospital
Yes
No
No
Children’s Hospital
Yes
No
No
PIP (Periodic Interim Payment) Hospital
Yes
No
No
State Certified Inpatient Psych Facility
Yes
No
No
Skilled Nursing Facility/ Swing Bed (please note, no pay bills may span both provider and federal fiscal year)
Yes
Yes
No
CAH Swing Bed
Yes
No
Yes

Inpatient Split Billing Examples
Your fiscal year end is June 30, 2016. The patient was admitted on June 28, 2016, and was discharged home on July 3, 2016. Submit the claims as follows:

1st claim (submitted first)

  • Type of bill = 112 (first in a series of claim)
  • Admission Date = 6/28/2016
  • From Date and Through Date= 6/28/2016 through 6/30/2016
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 114 (discharge bill)
  • Admission Date = 6/28/2016
  • From Date and Through Date = 7/1/2016 through 7/3/2016
  • Patient Status = 01 (discharged home)

Your fiscal year end is June 30, 2016. The patient was admitted on June 25, 2016, and discharged home on July 1, 2016. The claims should be submitted as follows:

1st claim (submitted first)

  • Type of bill = 112 (first in a series of claim)
  • Admission Date = 6/25/2016
  • From Date and Through Date= 6/25/2016 through 6/30/2016
  • Patient Status = 30 (still patient)

2nd claim (wait till the first claim finalizes)

  • Type of bill = 114 (discharge bill)
  • Admission Date = 6/25/2016
  • From Date and Through Date = 7/1/2016 through 7/1/2016
  • 0 covered days
  • Patient Status = 01 (discharged home)

Note: All ancillary charges that occurred on the date of discharge are included on this claim.

Outpatient
All inpatient Part B and outpatient claims require a line item date of service for each revenue code line reported in FL 45 of the UB-04 claim form or its electronic equivalent.

There must be a single line item date of service (LIDOS) for every revenue code line reporting a Healthcare Common Procedure Coding System (HCPCS) on the claim.

If a line item date of service is not reported on each revenue code line, or the line item dates of service reported are outside the statement-covers period, your claim will be returned.

Outpatient Split Billing
There are times when an outpatient claim may cross over the provider’s fiscal year end, the federal fiscal year end, or calendar year end. The following chart provides guidance on billing in these situations. 

Provider Type
Provider’s Fiscal Year End
Federal Fiscal Year End
Calendar Year End
Outpatient Hospital Services (PPS and Non PPS)
Yes
No
Yes
Maryland Waiver Hospitals
Yes
No
Yes
Indian Health
Yes
No
Yes
Critical Access Hospital
Yes
No
Yes
Federally Qualified Health Center
Yes
No
Yes
Rural Health Center
Yes
No
Yes
Outpatient Rehab Facility
Yes
No
Yes
Comprehensive Outpatient Rehab Facility
Yes
No
Yes
Emergency Room/Observation Services
Yes
No
Yes
All Other Outpatient Facilities
Yes
No
Yes

Outpatient Split Billing Example
Provider’s fiscal year end is June 30, 2016. The patient was seen in the emergency department on 6/30/2016, was placed in observation on June 30, 2016, for 32 hours and was discharged home on July 1, 2016. The claims will be submitted as followed:

1st claim (submitted first)

  • Type of bill = 132 (first in a series of claim)
  • From Date and Through Date= 6/30/2016 through 6/30/2016
  • Patient Status = 30 (still patient)

Note: All hours of observation is included on this claim

2nd claim (wait till the first claim finalizes)

  • Type of bill = 134 (discharge bill)
  • From Date and Through Date = 7/1/2016 through 7/1/2016
  • Patient Status = 01 (discharged home)

Note: All ancillary charges that occurred on July 1, 2016, are included on this claim.

Outpatient Rehabilitation
Outpatient rehabilitation providers and Comprehensive Outpatient Rehabilitation Facilities must report all services billed by line item date of service. This means each service provided must be repeated on a separate revenue code line along with the specific date of service.

If a line item date of service is not reported on each revenue code line, or the line item dates of service reported are outside of the statement-covers period, your claim will be returned.

Observation
If a period of observation (HCPCS code G0378) spans more than one calendar day, all hours for the entire period of observation must be included on a single line and the date of service for that line is the date observation care began.

For example, a patient was admitted to observation on January 15, 2017, at 10 p.m., and ended at 12 p.m. on January 16, 2017. The date of service reported on the observation room revenue code line is January 15, 2017, the date observation services began.

Remember, your observation services claim must also include one of the services listed below with a line item date of service on the same day or the day before observation services began.

  • An emergency department visit (Ambulatory Payment Classification (APC) 0609, 0613, 0614, 0615, 0616) or
  • A clinic visit (APC 0604, 0605, 0606, 0607, 0608) or
  • Critical care (APC 0617) or 
  • Direct referral for observation care reported with HCPCS code G0379 (APC 0604) must be reported on the same date of service as the date reported for observation services.

No procedure with a T status indicator can be reported on the same day or day before observation care is provided.

Clinical Lab Services — Specimen Collection
The date of service policy for clinical laboratory test/service must be the date the specimen was collected. 

If the collection spans two or more calendar dates, the date of service is the date the collection ended. 

Exceptions
Tests/Services Performed on Stored Specimens
If a specimen was stored for less than or equal to 30 calendar days from the date it was collected, the date of service of the test/service must be the date the test/service was performed only if:

  • The test/service is ordered by the patient’s physician at least 14 days following the date of the patient’s discharge from the hospital;
  • The specimen was collected while the patient was undergoing a hospital surgical procedure;
  • It would be medically inappropriate to have collected the sample other than during the hospital procedure for which the patient was admitted;
  • The results of the test/service do not guide treatment provided during the hospital stay; and
  • The test/service was reasonable and medically necessary for treatment of an illness

If the specimen was stored for more than 30 calendar days before testing, the specimen is considered to have been archived and the date of service must be the date the specimen was obtained from storage.

Chemotherapy Sensitivity Tests/Services Performed on Live Tissue
The date of service of a chemotherapy sensitivity test/service performed on live tissue must be the date the test/service was performed only if:

  • The decision regarding the specific chemotherapeutic agents to test is made at least 14 days after discharge;
  • The specimen was collected while the patient was undergoing a hospital surgical procedure;
  • It would be medically inappropriate to have collected the sample other than during the hospital procedure for which the patient was admitted;
  • The results of the test/service do not guide treatment provided during the hospital stay; and
  • The test/service was reasonable and medically necessary for treatment of an illness

For purposes of applying this exception, a “chemotherapy sensitivity test” is defined as a test that requires a fresh tissue sample to test the sensitivity of tumor cells to various chemotherapeutic agents.

Partial Hospitalization
Hospitals, other than Critical Access Hospitals and Community Mental Health Clinics, are required to report line-item dates of service for each revenue code line.

Each service provided must be repeated on a separate line item along with the HCPCS codes and specific dates of service for each occurrence.

Example
Patient is admitted and discharged from a partial hospitalization course of treatment in the same month.

Patient is admitted and discharged from a partial hospitalization course of treatment in the same month.

Emergency Room
The line item date of service for the Emergency Room (ER) service is the date the patient entered the ER even if it spans multiple service dates.

For all other services related to the ER encounter (i.e., lab, radiology, etc.) the line item date of service reported is the date the service was actually rendered.

References

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

Contact a specific JJ Part A department


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