For institutional claims (other than inpatient acute care hospital) for items and services that meet the definition of “health benefits” under the program, when are costs incurred, for ERRP purposes?
45 C.F.R. § 149.2 defines “incurred” as “the point in time when the sponsor, health insurance issuer (as defined in 45 CFR § 160.103), employment-based plan, plan participant, or a combination of these or similar stakeholders, become responsible for payment of the claim.” CMS interprets this regulatory definition to mean, with respect to costs for items and services furnished by institutions (other than inpatient acute care hospitals), to be the “FROM Date of Service” for the specific item or service specified on the bill. As compared to individuals who are inpatients in an acute care hospital, individuals in other types of institutions might remain in the institution and receive items and services for a significantly longer period of time. So, the institution may submit multiple bills with different FROM Dates of Service for the same individual. Due to these situations, we believe that the FROM Date of Service is the appropriate incurred date in these settings. The date of admission m
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