Interim billing guidelines for inpatient acute-care PPS hospitals, inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs) and inpatient psychiatric facilities (IPFs)
Interim billing allows hospitals to receive partial payments while a patient remains admitted, instead of waiting until discharge to submit the entire claim for payment.
Interim billing is common due to long lengths of stay because LTCHs treat complex, long-stay acute patients.
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Medicare allows interim billing during extended admissions
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Type of bill (TOB) 11X with interim claims typically every 30 days, up to 60-day intervals
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Interim billing does not end the inpatient stay, only the submission of the final discharge claim does
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Final payment is settled upon discharge
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Accurate documentation and compliance with CMS guidance are critical
Type of bill (TOB)
For a continuous course of treatment, claims must be submitted in the order in which the services were delivered.
TOB 11X for inpatient services:
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111 – Admit through discharge (final bill)
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112 – Interim – First claim
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113 – Interim – Continuing claim
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114 – Interim – Last claim (if applicable before final)
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117 - Adjustment or Interim
Patient status
The patient discharge status code in UB-04 form locator 17 (or electronic equivalent) is a required field and must align with the type of bill.
For any interim claim with a bill type code concluding in frequency code 2 or 3, the mandatory discharge code required in field 17 is 30, which signifies "Still a Patient.”
The last bill shall contain a discharge patient status code.
Codes used for Medicare claims are available from Medicare contractors. Codes are also available from the NUBC (www.nubc.org) via the NUBC’s Official UB-04 Data Specifications Manual.
Final discharge submission
Medicare billing guidelines allow for interim bills in at least 60-day intervals, using type of bill 112 (patient status 30), and subsequent interim bills when the beneficiary is still receiving inpatient care.
Hospitals must submit a final discharge bill when any of the following occur:
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Benefits are exhausted or
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The beneficiary ceases to need a hospital level of care (all hospitals); or
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The beneficiary is discharged or expired.
When a beneficiary’s Medicare benefits exhaust in an IPF or an LTCH, the hospital is allowed to submit a no-pay bill (TOB 110) with a patient status code 30 in 60-day increments until discharge. These providers do not have to continually adjust bills until physical discharge or death. The last bill shall contain a discharge patient status code.
References