N.H. Admin. Code § He-W 531.10

Current through Register No. 36, September 5, 2024

Section He-W 531.10 - Payment for Services

(a) Payment to physicians shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(b) The payment rates for surgery, established by the department in accordance with RSA 161:4, VI(a), shall be at a global rate in accordance with the CPT codes and National Correct Coding Initiative (NCCI) edits, inclusive of the following:

(1) Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia;

(2) Subsequent to the decision for surgery, any related evaluation and management encounter that occurs up to 5 days prior to or on the date of procedure, including history and physical;

(3) Immediate postoperative care, including dictating operative notes, and talking with the family and other physicians;

(4) Writing orders;

(5) Evaluating the patient in the post anesthesia recovery area; and

(6) Typical post-operative follow-up care up to 30 days post surgery.

(c) Rates established by the department in accordance with (a) above shall be considered to include all costs of doing business including, but not limited to:

(1) Missed or cancelled appointments; and

(2) Administrative services such as:

a. Copying records;

b. Referrals;

c. Renewing prescriptions; and

d. Providing medical documents for schools, sports, and camps.

(d) Payment for second surgical opinions shall be made in accordance with rates established by the department in accordance with RSA 161:4, VI(a).

(e) Physicians who request reimbursement for clinical laboratory services, in accordance with He-W 577, shall receive reimbursement provided that a contract or agreement exists between the physician and the laboratory and requests for reimbursement shall be made by the physician.

(f) The provider shall use CPT and HCPCS procedure codes when billing.

(g) The provider shall submit claims for payment to the department's fiscal agent.

(h) The provider shall maintain supporting records in accordance with He-W 520.

N.H. Admin. Code § He-W 531.10

Amended by Volume XXXIV Number 16, Filed April 17, 2014, Proposed by #10531, Effective 3/29/2014, Expires3/29/2024.

Amended by Volume XL Number 11, Filed March 12, 2020, Proposed by #12999, Effective 3/5/2020, Expires 3/5/2030.