Identify and discuss inpatient hospital claims. Include information about length of stay and coding for particular services

Question

What will be an ideal response?

Answer 1

Answer:
The provider of service is a facility that provides inpatient care. This may be a hospital, an acute care facility, a skilled nursing facility, a custodial care facility, or a similar facility.
For inpatient care, the patient must be admitted into the hospital and stay for a period of time, usually a minimum of 24 hours. There must be a room and board charge. A hospital room and board charge is similar to that for staying in a hotel. The day entered is paid but not the day discharged, as long as the discharge time is before the required checkout time. The UB-04 form should always indicate admission and discharge dates.
When coding inpatient hospital claims, the CPT® or RVS books are not used unless the billing has itemized some charges according to valid CPT®/RVS codes. Each payer has its own coding guidelines. Therefore, before a claim can be coded for processing, the payer-specific codes must be obtained. Most payers break up the bills according to:
• Room and board charges
• Ancillary charges
• Take-home prescriptions
• Professional fees for exams, surgery, etc.