CMS Pub. 100-04, ch. 3, § 140.3.1

To ensure that revenue code 0024 is not reported more than once on bill type 11X;

• To ensure the claim can be matched to the corresponding Inpatient Rehabilitation

Facility – Patient Assessment Instrument (IRF-PAI) assessment in the internet

Quality Improvement Evaluation System (iQIES)

• To compare applicable inpatient claims with post-acute claims that will allow

erroneous claims to be reviewed and appropriate adjustments to be made on an

ongoing basis to the discharging hospital’s inpatient claim.

• To check the incoming claims admission date to the history discharge date for the

same provider except when patient status code is 30 (CWF);

• To check the incoming claim’s discharge date to the history admission date for the

same provider (CWF);

• To reject subsequent claims with the same PPS provider on the same day (CWF);

• Ensure accurate coding of patient status codes by checking the incoming claim’s

admission date to the history discharge date;

o CWF accepts the incoming claim and sends an informational

unsolicited response to the A/B MAC (A) on the history claim if the

patient status code does not match the incoming provider number

o The A/B MAC (A) cancels the history claim to the provider

• To check incoming claim’s discharge date to the history admission date to ensure

the appropriate use of the patient status code on the incoming claim;

• CWF rejects the incoming claim if the patient status code does not match the

provider number;

• A/B MAC (A) returns the incoming claim to the provider for correction of the

patient status code.

• To insure that revenue code 0024 is only on claims submitted by IRF providers.

Bills submitted incorrectly will be returned to the provider.

• To insure that a valid HIPPS/CMG rate code is always present with revenue code

0024;

• Units entered on the 0024 must be accepted, but are not required.

• To insure that revenue code total charges line 0001 must equal the sum of the

individual total charges lines;

• To insure that the length of stay in the statement covers period, from and through

dates equals the total days for accommodations revenue codes 010x-021x,

including revenue code 018x (leave of absence)/interrupted stay,

• To insure that Occurrence Span Code 74 is present on the claim if there is an

interrupted stay < 3 days. If the interruption is greater than 3 days, the bill should

be considered a discharge. If the patient returns to the IRF by midnight of the 3rd

day, the bill continues under the same CMG. CWF will need to edit to ensure that

if another IRF bill comes in during the interrupted stay, it is rejected, as it should

be associated with the original CMG; and

• If HIPPS rate code is 5101, 5102, 5103, or 5104 patient status must be 20

(Expired)/

• The accommodation revenue code 018x (leave of absence) will continue to be used

in the current manner including the appropriate occurrence span code 74 and date

range.