Agencies
Services
Provider Notice issued 09/01/06
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Source of Admission D – Transfer from Hospital Inpatient in the Same Facility Resulting in a Separate Claim to the Payer.
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Patient Status Code 66 – Discharged/transferred to a Critical Access Hospital (CAH).
- Remove appendix Pages H-22f (1) and (2) dated March 1996 and replace with the updated Pages (1) and (2) dated July 2006.
- Remove appendix Page H-22f (4) dated August 2005 and replace with the updated Page (4) dated July 2006.
- Remove appendix Pages H-22f (4a) and (4b) dated August 2005 and replace with the updated Pages (4a) and (4b) dated July 2006.
New Source of Admission and Patient Status Codes for UB-92 and Cost Outlier Payment Calculation Revision
| To: | Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers |
| Date: | September 1, 2006 |
| Re: | New Source of Admission and Patient Status Codes for UB-92 and Cost Outlier Payment Calculation Revision |
The purpose of this bulletin is to provide information on new codes approved by the National Uniform Billing Committee (NUBC) and to advise providers of a change in the cost outlier payment calculation.
NUBC Codes
The NUBC has approved the use of a new Source of Admission code and Patient Status code. Both are effective with admissions occurring on and after January 1, 2006.
The DRG Payment Calculation Worksheet in Appendix H-22f, [Pages 1 and 2], of the Handbook for Hospitals has been updated to reflect the new codes.
Cost Outlier Payment Calculation
As a result of an amendment to 89 Illinois Administrative Code 152, the cost outlier payment calculation for admissions occurring on and after July 1, 2006, will change. An explanation of how the change impacts hospitals reimbursed by DRG and per diem reimbursement methodologies is provided below.
For DRG-reimbursed hospital services with admissions on and after July 1, 2006, the Specific Fixed Loss Threshold used in the cost outlier payment calculation will be multiplied by 1.47. The DRG Payment Calculation Worksheet in Appendix H-22f, [Page 4], of the Handbook for Hospitals has been updated to reflect the new multiplier.
For per diem-reimbursed hospital services with admissions on and after July 1, 2006, a factor of 0.18 will be used in the outlier payment calculation. The outlier payment calculation worksheet for per diem-reimbursed hospitals in Appendix H-22f, [Pages 4a and 4b], of the Handbook for Hospitals has been updated to reflect the new factor.
This bulletin and the replacement handbook pages may be obtained from the department’s Web site at: <http://www.hfs.illinois.gov/hospitals/>. The revisions in the replacement pages are identified by an “=” to the left of the affected text. Some revisions do reflect policy changes; however, others are simply updates in terminology. Paper copies of the revised pages may be obtained by written request. To ensure delivery, you must specify a physical street address when requesting a paper copy.
You may submit your written request to the address below, or fax or e-mail it as noted:
Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax Number: (217) 557-8800 / E-Mail Address:
hfs.webmaster@illinois.gov
Providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following HFS Web site:
http://www.hfs.illinois.gov/provrel
Electronic claim submission via the Internet is available by registering on the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System at: <http://www.myhfs.illinois.gov/>. The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.
Instructions for updating the Handbook for Hospitals:
Hospital Handbook replacements (pdf)