February 25, 2009

BC-09-05

MS-09-04

FEP:  When the Newborn Stays Longer Than Mother

There may be some confusion on how to submit a newborn FEP claim when the newborn stays longer than the mother. 

Allow me to clarify; hospitals are never to combine the mother's charges with the baby's charges.  Instead, hospitals should bill the mother's claim with all charges for the mother from the admission to discharge.  However, what has changed is how the newborn claim should be submitted.  Below are the changes:

• When the newborn remains in the hospital after the mother is discharged and revenue codes 173 (Level III sick neonates who do not require intensive care, but require 6-12 hours of nursing each day – Intermediate Care) or 174 (Level IV constant nursing and continuous cardiopulmonary and other support for severely ill infants – Intensive Care) are billed, we only need one claim for the newborn's stay showing charges from the date of birth to discharge.
  

• When the newborn remains in the hospital after the mother is discharged and revenue codes 173 or 174 are not included on the claim, then two claims need to be submitted for the newborn.  One claim showing the baby's charges up until the time the mother's discharge and the other showing charges after the mother's discharge.

This information will be placed in the Institutional Relations Revenue manual.

cg