Incremental Nursing Policy

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Policy Name

Incremental Nursing

Summary

This policy defines incremental nursing and Medica’s methodology for

reimbursement of these charges.

This reimbursement policy applies to services reported using the UB-04 claim

form or its electronic equivalent or its successor form.

Policy Statement

Per the UB-04 Manual, the 023x (Incremental Nursing Charge) range of

revenue codes describes “Extraordinary charges for nursing services assessed in

addition to the normal nursing charge associated with the typical room and board

unit.”

Incremental nursing revenue codes are therefore used to describe extraordinary

or non-routine nursing care services. They should not be used to unbundle and

separately report routine nursing charges.

Consistent with the intent of the 023x range of revenue codes, Medica will

consider incremental nursing charges for reimbursement when there is a medical

need for extraordinary or non-routine nursing services. The need for these

services must be supported in the medical record. In addition, when submitting

charges for incremental nursing services a brief explanation of the reason

additional, non-routine nursing services were necessary must be entered in the

Remarks Field (Form Locator 80) of the UB-04 or its electronic equivalent, the

837I.

Claims submitted with the 023x range of revenue codes are subject to post

payment audit and potential recoupment of payment for incremental nursing

services. Payment for incremental nursing charges will take into consideration

the average usual and customary room and board charges for the specific region

in which the care was provided. Routine nursing charges unbundled from

standard room and board will not be reimbursed.

Definitions

023x Incremental Nursing Charge - Extraordinary charges for nursing

services assessed in addition to the normal nursing charge associated with the

typical room and board unit. This code does not support unbundling of nursing

charges from standard room and board.

Revenue codes include:

0230 General Classification

0231 Nursery

0232 OB

Incremental Nursing Policy

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0233 ICU

0234 CCU

0235 Hospice

0239 Other

Resources

National Uniform Billing Committee Official UB-04 Data Specifications

Manual 2012

Effective Date

Revision

Updates

11/01/12

11/17/2016 Annual policy review

11/12/2015 Annual policy review

11/13/2014 Annual policy review

12/12/2013 Annual policy review

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health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company,

Medica Self-Insured, and Medica Health Management, LLC.