Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9500 - ASSISTANCE PAYMENTS PROGRAMS
HOSPITAL MEDICAL ASSISTANCE REIMBURSEMENT
Part 9500.1130 - PAYMENT PROCEDURES

Universal Citation: MN Rules 9500.1130

Current through Register Vol. 49, No. 13, September 23, 2024

Subpart 1. Submittal of claims.

Claims may not be submitted to the department until after a patient is discharged or 30 days after admission and every subsequent 30 days, whichever occurs first. A hospital that submits a claim to the department after 30 days from admission, but before discharge, shall submit a final claim after discharge.

Subp. 1a. Payor of last resort.

A hospital may not submit a claim to the department until a final determination of the patient's eligibility for potential third party payment has been made by a hospital. Any and all available third-party benefits must be exhausted prior to billing medical assistance and the third-party liability amounts must be entered on the claim.

Subp. 1b. Third-party liability.

Payment for patients that are simultaneously covered by medical assistance and a third party will be determined according to a hierarchy of application as set out in items A to E.

A. Medical assistance payment for a Medicare crossover will be determined by subtracting the third-party liability from the Medicare deductible and coinsurance due from the patient. A negative difference will not be implemented.

B. Medical assistance payment for a Medicare crossover whose Medicare benefits either exhaust or begin during an admission will be determined by subtracting the Medicare payment and third-party liability from the medical assistance rate. A negative difference will not be implemented.

C. Medical assistance payment will not be made for an admission when either charges are paid by a third party or the hospital has an agreement to accept payment for less than charges as payment in full.

D. Medical assistance payment for an admission under item C that requires a deductible or coinsurance will be made at a level equal to the deductible or coinsurance due from the patient.

E. Medical assistance payment for a patient with any third-party benefits will be determined as the lesser of the covered charges minus the third-party liability, or the medical assistance rate minus the third-party liability. A negative difference will not be implemented.

Subp. 1c. Reduction of recipient resources.

Recipient resources will also be reduced from the amounts in subpart 1b.

Subp. 2. [Repealed, 18 SR 1115]

Subp. 3. [Repealed, 18 SR 1115]

Subp. 4. [Repealed, 18 SR 1115]

Subp. 5. [Repealed, 18 SR 1115]

Subp. 6. [Repealed, 18 SR 1115]

Subp. 7. [Repealed, 18 SR 1115]

Subp. 8. [Repealed, 18 SR 1115]

Subp. 9. [Repealed, 18 SR 1115]

Subp. 10. [Repealed, 18 SR 1115]

Subp. 11. [Repealed, 18 SR 1115]

Subp. 12. [Repealed, 18 SR 1115]

Statutory Authority: MS s 256.9685; 256.969; 256.9695

Disclaimer: These regulations may not be the most recent version. Minnesota 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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