CMS Pub. 100-04, ch. 3, § 70.1

Some providers have been approved to bill a flat fee charge for inpatient services based on

either a daily basis or total stay basis for services furnished. This is an "All-Inclusive Rate."

These charges may cover room and board, including ancillary services, or room and board

only. These instructions explain the essential data entries that must be made using the ASC

X12 837 institutional claim format or on the Form CMS-1450 by providers that use all-inclusive rates as charges. All-inclusive rate providers are identified by one of the following

charge structures:

• One total all-inclusive charge rate for both accommodations and ancillary services,

including the cost of blood in the rate;

• One total all-inclusive charge rate for both accommodations and ancillary services,

not including the cost of blood in the rate;

• One all-inclusive charge rate for accommodations and another for ancillary services,

including the cost of blood in the all-inclusive rate; or

• One all-inclusive charge rate for accommodations and another for ancillary services,

not including the cost of blood in the all-inclusive rate.

Providers follow these special instructions for completing of the billing format or form.

A. - Accommodations

Revenue Codes - Codes that identify the accommodations furnished, ancillary services

provided or billing calculation are entered in this field. The code indicates whether the rate

includes charges for ancillary services or only room and board.

If the patient was furnished more than one type of accommodation, the loops or lines for

each type of accommodation are completed. This is necessary whether or not the provider

charges an all-inclusive rate according to accommodations.

Where the all-inclusive rate varies with the type of accommodation, the Remarks field is

annotated for a five-or-more bed accommodation showing the reason for the

accommodation.

Unit of Service - A quantitative measure for services furnished, by revenue category, to or

for the patient which includes items such as the number of accommodation days, pints of

blood, or renal dialysis treatments, is entered.

Total Charges - The total charges pertaining to the related revenue code for the current

billing period is entered.

Noncovered Charges - The total non-covered charges pertaining to the related revenue code

for the current billing period is entered.

B. - Ancillary Services

One All-Inclusive Charge Rate - Hospitals with one all-inclusive charge rate, including

ancillary services, are reflected in the revenue code. The total charge reflects the charge for

both accommodations and ancillary services.

Separate Ancillary All-Inclusive Rate - Some providers segregate charges for ancillary

services for billing purposes. Where a separate flat rate charge for ancillary services is

incurred either on a daily or total stay basis, the provider enters separate codes for the

services. These codes indicate whether the total charge includes only ancillary cost or

includes other costs (i.e., blood).

If applicable, the following additional billing instructions are applied:

• Blood

Whenever whole blood is furnished the patient, value codes and amounts are

completed. If the all-inclusive rate does not include the charge for whole blood or

packed cells, revenue codes, rates, service dates, units, and total charges are

completed in the same way a provider not using all-inclusive rates would complete

them. When the provider discounts its customary charges for unreplaced blood to

which the deductible is applicable, it shows the charges before the discount.

If the all-inclusive rate covers the cost of providing blood whenever a patient needs it,

the number of pints furnished, replaced, not replaced, and the estimated cost per pint

is entered in value codes and amounts. No amount can be shown in the Total

Charges column since the rate includes the cost of blood. It is not necessary to show

the cost for any replaced blood.

• All-Inclusive Charges According to Disease, Injury, or Type of Treatment

Providers that have a charge system based on the patient's illness or injury or type of

treatment complete the applicable loops or line(s) for type of accommodation

furnished showing number of days, rate, and total charges. The rate amount and total

amounts must be the same. Blood entries are indicated as above.

• Physician's Component

As with providers having a schedule of charges for individual services, the amount of

any physician's component included in the all-inclusive charge is removed from the

total covered charges before applying the inpatient deductible or coinsurance.

• Combined Billing

CMS does not encourage the all-inclusive rate provider to combine bill. However, if

it does, it must develop the capability and indicate in the Remarks field, the number

and type of each service it is combined billing. To identify such cases, the remark

"Combined Billing" must be written in the Remarks field.

NOTE: Combined billing was eliminated with Outpatient PPS.