D.C. Mun. Regs. tit. 29, r. 29-4812
Current through Register Vol. 71, No. 49, December 6, 2024
Rule 29-4812 - INPATIENT SERVICES: SHORT-TERM STAYS AND INELIGIBLE DAYS4812.1DHCF shall deny claims for Medicaid reimbursement arising out of a patient admission and discharge on the same date (same-day discharge); and shall instruct the billing provider to bill the services as outpatient services.
4812.2DHCF shall deny Medicaid reimbursement for same-day discharges unless the patient status indicates death.
4812.3DHCF shall identify a discharge as a one-day stay when the discharge date occurs on the day following the admission date.
4812.4DHCF may reimburse a one-day stay as follows:
(a) A claim reflecting a one-day stay may be reimbursed as a hospital stay, but may be subject to post-payment review of the medical necessity of the admission; or(b) A one-day stay may qualify for a low-cost outlier adjustment pursuant to the low-cost outlier.4812.5DHCF shall deny any claim for an inpatient stay that includes ineligible days.
4812.6A denied claim may be resubmitted for eligible days.
D.C. Mun. Regs. tit. 29, r. 29-4812
Final Rulemaking published at 45 DCR 4141, 4151 (June 26, 1998); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 4323, 4332 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); amended by Final Rulemaking published at 63 DCR 5234 (4/8/2016)29 DCMR § 4812 is formerly entitled SAppeals for Hospitals that are not Compensated on an APDRG Basis".Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2001; Supp. 2008)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2001; Supp. 2008)).