Hospital Billing Changes for Days Awaiting Placement (DAP)

Jul 29, 2024

MaineCare plans to make the following changes retroactive to July 1, 2024. These changes pertain to claims submitted with a “from” date of service of July 1, 2024, and forward. 

DAP Revised: 

Members who are classified as DAP for Nursing Facility (NF) will be receiving a per diem rate in addition to the Diagnosis-Related Group (DRG) payment. This per diem rate requires special billing. Revenue Code 0229 must be added to the claim along with the number of units associated with the revenue code. The units must equal the same number of units that are billed with Revenue Code 0160. The same billing rules for billing DAP before this change still apply.   

• Use the room and board revenue code (0160)
• Occurrence span (FL 35 - 36) should be 74 (non-covered level of care), and the dates should equal the “from” and “to” date on the claim, 
• Revenue codes with charges that are billable to Medicare part B cannot be on the claim.   

If you are billing Medicare Part A for covered and non-covered services, and you receive a DRG from Medicare, MaineCare will not pay a separate DRG. In this case, you would only bill Revenue Code 0229 with the number of units associated with the revenue code. Ancillary services should not be billed as there is no reimbursement beyond the per diem rate.  

Hospital billing staff must work closely with their Care Management Department to determine the type of classification that is being requested and approved. MaineCare will deny claims billed DAP for NF that do not have the appropriate classification.   

Reminder to Hospital Care Management Departments. When a patient is no longer at an acute level of care, and a notice of non-coverage is provided to the patient, a copy of the letter must be sent to MaineCare Services, Attn: Program Integrity Department, SHS 11/109 Capitol St., Augusta, ME 04333-0011, or fax (207) 287-2415. 

Swing Bed Reminder: 

Patients admitted to a swing bed status must meet a Skilled Nursing Facility (SNF) level of care to qualify for reimbursement. Per MaineCare Benefits Manual (MBM) hospital policy, Chapter II Section 45.01, swing beds can be used interchangeably as an acute level of care, or SNF level of care as defined in MBM Chapter II, Section 67. When the patient is at SNF level of care, they are granted 30 days of community MaineCare coverage. Any days beyond those 30 days cannot be reimbursed under community MaineCare. Swing beds cannot be used for DAP as that level of care does not qualify under the SNF category. 

For questions, please email Provider Relations Specialist Tiffany Norton.