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Hospital Billing Guidelines

Office of PolicyHospital Billing Guidelines Applies to dates of discharge and dates of service on or after September 1, 2021 Revised 7/26/2021 Page 2 of 98 TABLE OF CONTENTS New Changes for 9/1/2021 .. 6 Billing OVERVIEW .. 8 Provider Enrollment .. 9 UB-04 Instructions for Hospital Providers .. 9 CASES Billing INSTRUCTIONS .. 13 Transfer Billing ..13 Transfer between Acute Care and Medicare Distinct Part Psychiatric Units .. 13 Multiple Transfers between Acute Care and Medicare Distinct Part Psychiatric Units .. 14 Transfers between Acute and Distinct Part Rehabilitation Units .. 15 Interim Billing Instructions ..15 Adjustments to Paid Claims ..16 Denied/Problem Claims ..17 Pre-Certification, Prior Authorization Requirements, and Utilization Review ..17 Pre-Certification Psychiatric Admissions .. 17 Prior Authorization Medical and Behavioral Health .. 18 Prior Authorization Transplants .. 19 Utilization Review and Associated claim Resubmission.

Sep 01, 2021 · • An update to which bill types are accepted for outpatient services was also provided. (Refer to Section 3.3 ) • Section 3.5.2 referring to managed care carve outs for outpatient behavioral health claims was removed. • An update to edits concerning national drug codes (NDC’s) was added. (Refer to Section 3.6)

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