CMS Pub. 100-04, ch. 3, § 20.7.2

A3-3610.6, HO-415.9

Under PPS, split billing is not needed for cost reporting purposes; however, it is necessary to

show on the bill the coinsurance days in each calendar year for proper application of the

coinsurance amount.

For admissions prior to the cost reporting year under IPPS with a discharge after the

beginning of the prospective payment year, the DRG payment for the discharge is reduced by

the cost of services furnished in the prior period.

The hospital uses the day or charge statistics on the bill representing the portion of the stay in

the prior period to determine the cost of the services furnished. Split bills are not needed at

the end of the government's fiscal year or the calendar year as changes in DRG prices are

determined by the date of discharge. This is shown in value codes 09 (first year coinsurance)

and 11 (second year coinsurance). (See Chapter 25.)

PPS days on the cost report are allocated to the year of the discharge. Hospitals not on IPPS,

LTCHPPS, or IRFPPS continue to submit split bills at the end of their fiscal years and

allocate the days to the hospital year in which they occurred.

When split billing applies, DRG payments are made only on bills that show a discharge date

and status. No DRG payment is made on PPS bills that show "still patient" status.

The hospital may not split a bill for the periods before and after the onset of capital PPS that

fall into the same billing period. Capital payment issued for an inpatient hospital stay that

begins prior to and ends after the onset of capital PPS is the amount determined by Pricer for

that DRG. No reasonable cost capital pass through payment is payable for the portion of the

stay that pre-dates capital PPS.