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Nursing Facility Bed Hold Days

June 11, 2018

The Blue Cross and Blue Shield of New Mexico (BCBSNM) Long Term Care (LTC) Provider Relations Team has recently received an increased number of inquiries surrounding bed hold days from contracted nursing facilities in the Blue Cross Community CentennialSM network. Please see the information below from page S39 of the Blue Cross Community Centennial section of the BCBSNM Provider Reference Manual for further clarification on billing and authorizations.

Nursing Facility Billing Requirements
The New Mexico Human Services Department (HSD) has standardized the nursing facility billing requirements for all Medicaid payers. Please bill these services on the UB-04 form with the codes outlined below :

Revenue Codes :
Bill with the following revenue codes for the services listed :

  • 0182 – Home Visit or Discharge Reserve Bed Day (three days allowed without prior authorization)
  • 0185 – Inpatient Hospital Reserve Bed Day (six days allowed without prior authorization)
  • 0190 – Subacute Care Long Term Care Services – Nursing Facility
  • 0199 – High Nursing Facility Level of Care

Value Codes :

  • Value Code 23 - Please remember to add value code 23 (patient estimated responsibility) to indicate the Medical Care Credit (MCC) for each recipient.
  • Value Code 80 - Non-covered reserve bed days must be billed as value code 80 for non-covered days.
  • Value Code 81 - Non-covered days plus covered days, billed as value code 81, must equal total days.

Patient Discharge Status :

  • Always use the appropriate patient discharge status code to indicate the recipient’s status on the last day of the period for which payment is requested.
  • When using discharge status code 30 (still a patient), the “TO” date of service is counted in the days billed.
  • As part of the discharge plan: An additional strong>six reserve bed days per calendar year are allowed with prior approval to support an eligible recipient or member resident to adjust to a new environment as part of their discharge plan.

For more information, please refer to NMAC Section 8.312.2 Long Term Care Services - Nursing Services, Nursing Facilities or contact your BCBSNM LTC Provider Representative .


 

Such services are funded in part with the State of New Mexico.