Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 21 - REHABILITATION CARE IN HOSPITALS
Section 471-21-004 - Billing and Payment for Chiropractic Services
Universal Citation: 471 NE Admin Rules and Regs ch 21 ยง 004
Current through March 20, 2024
21-004.01 Billing
21-004.01A
General Billing Requirements: Providers shall comply
with all applicable billing requirements codified in 471 NAC Chapter 3. In the
event that billing requirements in 471 NAC Chapter 3 conflict with billing
requirements outlined in this 471 NAC Chapter 21, the billing requirements in
471 NAC Chapter 21 shall govern.
21-004.01B
Specific Billing
Requirements
21-004.01B1
Billing Instructions: The provider shall bill Medicaid
in accordance with the billing instructions included in this Chapter
21-004.02 Payment
21-004.02A
General Payment Requirements: Medicaid will reimburse
the provider for services rendered in accordance with the applicable payment
regulations codified in 471 NAC Chapter 3. In the event that payment
regulations in 471 NAC Chapter 3 conflict with payment regulations outlined in
this 471 NAC Chapter 21, the payment regulations in 471 NAC Chapter 21 shall
govern.
21-004.02B
Specific Payment Requirements
21-004.02B1
Payment for Inpatient
Care: All rehabilitation services, regardless of the type of
hospital providing the service, will be reimbursed on a per diem basis. This
includes services provided at a facility enrolled as a provider for
rehabilitation services which is not a licensed rehabilitation hospital or a
Medicare-certified distinct part unit. The per diem rate will be the sum of the
following:
1. The hospital-specific base
payment per diem rate (See Appendix 471-000-82, Inpatient Hospital Services,
Section III.A.1);
2. The
hospital-specific capital per diem rate (See Appendix 471-000-82, Inpatient
Hospital Services, Section III.A.2); and
3. If applicable, the hospital's direct
medical education per diem rate (See Appendix 471-000-82, Inpatient Hospital
Services, Section III.A.3).
Payment for each discharge equals the per diem rate times the number of approved patient days. Payment is made for the day of admission but not for the day of discharge.
21-004.02B2 Payment for Outpatient Hospital
and Emergency Room Services: See 471 NAC 10-010.06, Payment for Outpatient
Hospital and Emergency Room Services
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