Providers submit one bill for covered days and days of leave when the patient is ultimately
discharged.
The provider bills for covered days with days of leave included in Noncovered Days.
Noncovered charges for leave of absence days (holding a bed) may be omitted from the
bill or may be shown under revenue code 018x. Providers will be instructed by their A/B
MAC (A) on which billing method to use. Occurrence span code 74 is used to report the
dates the leave began and ended. Although the Medicare program may not be billed for
days of leave, the provider is not permitted to charge a beneficiary for them.
Where a patient on leave of absence from a non-PPS hospital who was shown as "Still
Patient" (patient status code 30) on an interim bill:
• Has not returned within 60 days, including the day leave began, or
• Has been admitted to another institution at any time during the leave of absence,
submit an adjusted bill.
The hospital shows the day the patient left the hospital as the date of discharge. (A
beneficiary cannot be an inpatient of two institutions at the same time.)
NOTE: Home health or outpatient services provided during a leave of absence do not
affect the leave and no discharge bill is required unless the above events occur.
Outpatient Services Treated as Inpatient Services
A. - Outpatient Services Followed by Admission Before Midnight of the Following
Day (Effective For Services Furnished Before October 1, 1991)
When a beneficiary receives outpatient hospital services during the day immediately
preceding the hospital admission, the outpatient hospital services are treated as inpatient
services if the beneficiary has Part A coverage. Hospitals and A/B MACs (A) apply this
provision only when the beneficiary is admitted to the hospital before midnight of the day
following receipt of outpatient services. The day on which the patient is formally
admitted as an inpatient is counted as the first inpatient day
When this provision applies, services are included in the applicable PPS payment and not
billed separately. When this provision applies to hospitals and units excluded from the
hospital PPS, services are shown on the bill and included in the Part A payment.
B. - Preadmission Diagnostic Services (Effective for Services Furnished On or After
January 1, 1991)
Diagnostic services (including clinical diagnostic laboratory tests) provided to a
beneficiary by the admitting hospital, or by an entity wholly owned or wholly operated by
the admitting hospital (or by another entity under arrangements with the admitting
hospital), within 3 days prior to and including the date of the beneficiary's admission are
deemed to be inpatient services and included in the inpatient payment, unless there is no
Part A coverage. For example, if a patient is admitted on a Wednesday, outpatient
services provided by the hospital on Sunday, Monday, Tuesday, or Wednesday are
included in the inpatient Part A payment.
This provision does not apply to ambulance services and maintenance renal dialysis
services .
Additionally, Part A services furnished by skilled nursing facilities, home health agencies,
and hospices are excluded from the payment window provisions.
For services provided before October 31, 1994, this provision applies to both hospitals
subject to the hospital inpatient prospective payment system (IPPS) as well as those
hospitals and units excluded from IPPS.
For services provided on or after October 31, 1994, for hospitals and units excluded from
IPPS, this provision applies only to services furnished within one day prior to and
including the date of the beneficiary's admission. The hospitals and units that are
excluded from IPPS are: psychiatric hospitals and units; inpatient rehabilitation facilities
(IRF) and units; long-term care hospitals (LTCH); children’s hospitals; and cancer
hospitals.
