Change Request Detail
No.
1113
Date
12/17/2010
Submitter
Type of Request
Health Care Eligibility Requests or Responses
Status
DSMO Process Completed
Business Reason
For psychiatric hospitals to bill Medicare covered and non-covered days correctly, the number of lifetime pyschiatric days needs to be returned on the eligibility request.  Without this, on the front end staff either have to do a manual eligibility check and record it; or on the back end Medicare will adjust the claim, creating additional adjustments in the billing/accounting systems.
Suggestion
Add remaining lifetime psychiatric day field to the 5010
DSMO Category
D
Recommendation
Disapprove. The TR3 already accommodates this capability with the 271 response already supports the reporting of lifetime remaining psychiatric days.

If clarification is needed, the submitter may submit a Request for Interpretation through the ASC X12 Portal at http://www.x12.org/x12org/subcommittees/x12rfi.cfm
Appeal Recommendation