Section 29-4812. INPATIENT SERVICES: SHORT-TERM STAYS AND INELIGIBLE DAYS

 

4812.1 DHCF 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.

 

4812.2 DHCF shall deny Medicaid reimbursement for same-day discharges unless the patient status indicates death. 

 

4812.3 DHCF shall identify a discharge as a one-day stay when the discharge date occurs on the day following the admission date. 

 

4812.4 DHCF 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.

 

4812.5 DHCF shall deny any claim for an inpatient stay that includes ineligible days.

 

4812.6 A denied claim may be resubmitted for eligible days.

 

 

authority

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. 744; D.C. Official Code § 1-307.02 (2014 Repl.& 2015 Supp.)) 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) (2012 Repl.)).

source

Final Rulemaking published at 45 DCR 4141, 4151 (June 26, 1998); as amended by Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Final Rulemaking published at 58 DCR 4323, 4332 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); as amended by Final Rulemaking published at 63 DCR 5234 (April 8, 2016).