N.M. Admin. Code § 8.302.2.14

Current through Register Vol. 36, No. 1, January 14, 2025

Section 8.302.2.14 - BILLING AND PAYMENT LIMITATIONS

A.Payment not allowed: MAD does not pay factors either directly or by power of attorney 42 CFR Section 447.10(h). A factor is an individual or an organization, such as a collection agency or service bureau.

B.No reimbursement for the discharge day: An institutional or other residential provider, such as a NF, a hospital, an ICF-IID, and a provider of treatment foster care services are reimbursed for services furnished to an eligible recipient or member on the day of admission but are not reimbursed for services furnished on day of discharge.

C.No payment made for wrong services: A provider shall not bill MAD for:

(1) services provided to the wrong patient;

(2) a service performed on the wrong body part of an eligible recipient or member; and

(3) an incorrect procedure performed on an eligible recipient or member.

D.Payments for acquired conditions: MAD may deny or limit payment on claims for services to treat an eligible recipient or member for a condition acquired during the course of a facility stay or in the rendering of other services.

N.M. Admin. Code § 8.302.2.14

8.302.14 NMAC - Rp, 8.302.14 NMAC, 1-1-14, Amended by New Mexico Register, Volume XXV, Issue 19, October 15, 2014, eff. 10/15/2014, Adopted by New Mexico Register, Volume XXVIII, Issue 18, September 26, 2017, eff. 10/1/2017