Long-Term Care

Part B general billing requirements

Billing Alert for Long-Term Care, August 1, 2010

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Bill types. Under Part B, there are two types of bills (TOB) which are reflected on the UB-04 Medicare claim form: 22X (inpatient) and 23X (outpatient). CMS has confirmed that the SNF should use TOB 22X for any inpatient, whether the person is in a Medicare-certified bed or a noncertified bed. Use TOB 23X only for patients who live in the community and receive outpatient services from your SNF. Code the TOB (22X or 23X) in form locator 4 of the UB-04.

Fee schedules. A fee schedule, also referred to as a fee screen, is a complete list of fees used by Medicare to pay doctors, providers, and suppliers. This comprehensive list of fee maximums is used to reimburse a nursing home or other providers on a fee-for-service basis. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies.

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