Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 7 - STANDARDS FOR PAYMENTS
Section R9-22-712.45 - Outpatient Hospital Reimbursement: Outpatient Payment Restrictions
Universal Citation: AZ Admin Code R 9-22-712.45
Current through Register Vol. 30, No. 52, December 27, 2024
A.AHCCCS shall not reimburse hospitals for emergency room treatment, observation hours, or other outpatient hospital services performed on an outpatient basis if the member is admitted as an inpatient to the same hospital directly from the emergency room, observation, or other outpatient department.
B.AHCCCS shall include payment for the emergency room, observation, and other outpatient hospital services provided to the member before the hospital admission in the AHCCCS Inpatient Tiered Per Diem Capped Fee-For-Service Schedule under Article 7 of this Chapter.
C.Same day admit and discharge.
1. For discharges before September 30, 2014.
Same day admit and discharge claims that qualify for either the maternity or
nursery tiers shall be paid based on the lesser of the rate for the maternity
or nursery tier, or the outpatient hospital fee schedule.
2. For discharge dates on and after October
1, 2014. Same day admit and discharge claims are paid for through the
outpatient fee schedule.
Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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