N.J. Admin. Code § 10:66-4.2

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:66-4.2 - Hospital visits

(a) An inpatient hospital visit performed by a clinic physician for a registered Medicaid or NJ FamilyCare fee-for-service patient of a Federally qualified health center shall be reimbursed only if the clinic is specifically approved to provide this service by the programs.

1. For a salaried physician in a Federally qualified health center, an inpatient hospital visit shall be billed by the FQHC as a medical encounter.

2. For a physician under contract with a Federally qualified health center, the physician may receive reimbursement as an individual provider as long as the clinic is not also billing for the same service. The only contracted physician's costs that may be reported in the FQHC's Medicaid cost report are for visits that are billed by the FQHC.

N.J. Admin. Code § 10:66-4.2

New Rule, R.1998 d.577, effective 12/7/1998.
See: 30 New Jersey Register 3434(a), 30 New Jersey Register 4225(b).
Former N.J.A.C. 10:66-4.2, Audited financial statement, recodified to N.J.A.C. 10:66-4.3.
Amended by R.2004 d.208, effective 6/7/2004.
See: 36 New Jersey Register 324(a), 36 New Jersey Register 2834(a).
In (a), substituted "FamilyCare" for "KidCare" in the introductory paragraph.