CMS Pub. 100-04, ch. 3, § 190.12.1

Effective December 3, 2007, for payment purposes, an IPF discharge occurs when benefits

exhaust and the date benefits exhaust (if present) will substitute for the ‘actual’ discharge

date. The claim is paid based on the benefits exhaust date if present rather than the

discharge date. The Pricer version used to price claims for the discharge is when the

services actually were provided (i.e., when the Medicare beneficiary has Medicare

benefits). No pay/110 TOBs are allowed instead of continually adjusting the claims (117

TOB) until actual discharge occurs once benefits exhaust.

Under TEFRA, the PS&R report used the benefits exhaust date as the discharge date (if

present). This changed when the IPF PPS was implemented, and the 'actual' discharge

date was used. The days stay with the year they occurred, making it easier for the PS&R

report (especially during the blend period) to settle the cost report. This means that:

1. Claims will now be settled on the appropriate cost report;

2. The appropriate PPS-TEFRA blend percentage will be paid;

3. Patients with long lengths of stay will be counted on the correct PS&R report;

4. The PRICER version used will be the one in effect at the time the services

were provided (i.e., when the Medicare beneficiary actually has Medicare

benefits).