Long-term care hospital (LTCH) interim billing guidelines
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.
For LTCHs, 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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LTCHs use 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.
LTCHs use Type of Bill 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.”
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
For beneficiaries in a Long-Term Care Hospital (LTCH) requiring a long confinement period, Medicare billing guidelines allow for LTCHs to interim bill 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.
LTCHs are allowed to submit no-pay bills (TOB 110) once benefit’s exhaust, every 60 days. They do not have to continually adjust bills until physical discharge or death once benefit’s exhaust.
The last bill shall contain a discharge patient status code.
References