Chapter 514 - Nursing Facility Services - DHHR - State of West ...

certification must include documentation by the physician substantiating the resident'sneed for continued services in the nursing facility.Hospital transfer information (where applicable).Discharge summary completed by the physician prior to the resident's discharge fortransmittal to the receiving institution at the time the resident is discharged, ifapplicable.A record of the resident's major grievances, if any, and the disposition.Laboratory, x-ray and other diagnostic reports.A list of medications transferred to the resident or responsible party upon discharge, toinclude a medication disposition form signed and dated by the receiving individual andthe discharging nurse.Pre-Admission Screening (PAS) form.514.12 PAYMENT AND BILLING PROCEDURESNursing facility providers must comply with the payment and billing procedures andrequirements as noted below and found in Common Chapter 600, ReimbursementMethodologies.514.12.1 Payment and Billing Procedures Non-HospiceNursing facilities must bill for services using either the UB04 paper form or the 837i electronicinstitutional format. The services may not be billed until the following month after which theservices were provided.Nursing facilities will use bill type 21X. The following are the revenue codes and the HealthInsurance Prospective Payment System (HIPPS) codes that must be billed in order to receiveappropriate payment for services provided:Revenue Code 0190 is the room and board (fixed portion of the rate);Revenue Code 0550 in skilled nursing (nursing portion of the rate) and must haveHIPPS/RUGs Code attached;o HIPPS/RUGs Codes are AAA01-AAA29 to identify the West Virginiaspecific case mix classo HIPPS/RUGs Code AAA00 is to identify there is no MDS available;Revenue Code 0183 is the therapeutic bed hold leave of absence;Revenue Code 0185 is the hospital bed hold leave of absence andRevenue Code 0189 is the non-covered leave of absence.514.12.2 Nursing Facility Billing Procedures for Hospice PatientsTo be billed under Revenue Code 0658:Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 52January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.