Long Term Care Contents
PART 2 – MEDI-CAL BILLING AND POLICY
The Contents is a list of sections contained in the Part 2 Long Term Care manual. Section titles appear in alphabetical order. The “locator key” is an abbreviated form of the section title at the top of each page for skimming and identifying sections. For detailed topic entries within Part 1 and Part 2, refer to the Manual Index in the Indexes and Glossary manual.
Section Title Locator Key
A
Accommodation Codes for Long Term Care accom cd ltc
Admissions and Discharges admis
Appeal Form Completion appeal form
C
Child Health and Disability Prevention (CHDP) Program child
CIF Completion cif co
CIF Special Billing Instructions for Long Term Care cif sp ltc
CIF Submission and Timeliness Instructions cif sub
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Section Title Locator Key
D
Distinct-Part Long Term Care Facilities distinct
F
Forms: Legibility and Completion Standards forms leg
Forms Reorder Request: Guidelines forms reo
Forms Reorder Request: Long Term Care forms reo ltc
I
Incontinence Medical Supplies incont
L
Leave of Absence and Bed Hold leave
Licensing and Certification for Long Term Care licens ltc
Skilled Nursing Facility/Intermediate Care Facility Physician Recertification
for Medi-Cal (form)
M
Medicare/Medi-Cal Crossover Claims: Long Term Care medi cr ltc
Medicare/Medi-Cal Crossover Claims: Long Term Care Billing Examples medi cr ltc ex
Mental Disease Institutions Directory mental
O
Optional Benefits Exclusion opt ben exc
Other Health Coverage (OHC) oth hlth
Long Term Care (LTC) Insurance Denial of Coverage Referral (form)
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Section Title Locator Key
P
Patient Plans of Care for Long Term Care patient ltc
Payment Request for Long Term Care (25-1) Completion pay ltc comp
Payment Request for Long Term Care (25-1): Submission and
Timeliness Instructions pay ltc sub
Payment Request for Long Term Care (25-1): Tips for Billing pay ltc tips
Preadmission Screening Resident Review (PASRR) preadmis
Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry) prov bil
R
Rates: Facilities rate facil
Rates: Facility Per Diem rate facil diem
Rates: Facility Reimbursement – Miscellaneous Inclusive
and Exclusive Items rate facil misc
Remittance Advice Details (RAD) remit adv
Remittance Advice Details (RAD) Examples: Long Term Care remit ex ltc
Remittance Advice Details (RAD): Payments and Claim Status remit pay
Resubmission Turnaround Document (RTD) Completion resub comp
Rural Hospital Swing Bed Program rural hosp
S
Share of Cost (SOC): 25-1 for Long Term Care share ltc
Sign Language Interpretation sign
Subacute Care Programs: Adult subacut adu
Subacute Care Programs: Billing Codes subacut code
Subacute Care Programs: Level of Care for
Adults and Children subacut lev
Information for Authorization/Reauthorization of Subacute Care Services –
Adult Subacute Program (form)
Subacute Care Programs: Pediatric subacut ped
iii
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November 2015
Section Title Locator Key
T
TAR Completion for Long Term Care tar comp ltc
TAR Criteria for DP/NF Authorization (Hudman v. Kizer) tar crit dp
Family Certification (form)
Medical Certification (form)
Call List for NF Placement (form)
TAR Criteria for NF Authorization (Valdivia v. Coye) tar crit nf
TAR Deferral/Denial Policy (Frank v. Kizer) tar defer
TAR Field Office Addresses tar field
TAR for Long Term Care: 20-1 Form tar ltc
LTC TAR Submission: Required Documents (form)
TAR for Long Term Care: MDS Form tar ltc mds
TAR Submission: Transmittal Form tar submis
TAR: Submitting Appeals tar submit
U
Utilization Review: ICF/DD, ICF/DD-H and ICF/DD-N Facilities util review
iii
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November 2015