Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 25 - Hospital Reimbursement Schedule, Billing Instruction and Maintenance Procedures
Section I-2507 - Outpatient Reimbursement
Current through Register Vol. 50, No. 9, September 20, 2024
A. Outpatient hospital and ambulatory surgery services will be reimbursed at covered charges less a 10 percent discount. The formula for calculating payment amount is:
(Billed Charges) - (Noncovered Charges) = Covered Charges x 0.90 = Payment Amount
B. If a patient is admitted as an outpatient, however; is in the hospital overnight, this will be considered outpatient services. When patient is in hospital by midnight census of day two, this becomes an inpatient admission, thus services are paid at per diem rate. In addition, all procedures which can safely be performed as outpatient procedures shall be reimbursed as such. (Reference the Utilization Review Procedures, Chapter 27).
C. For a hospital admission to be subject to inpatient reimbursement, it must be medically necessary and not solely for the convenience of the payor.
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.
