Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PAYMENT FOR HOSPITAL SERVICES
Section 1163.63 - Billing requirements
Universal Citation: 55 PA Code ยง 1163.63
Current through Register Vol. 54, No. 44, November 2, 2024
(a) The hospital shall submit invoices to the Department in accordance with the instructions in the Provider Handbook.
(b) The hospital may not submit an invoice until the recipient has been one of the following:
(1) Discharged from the hospital as defined
in §
1163.51 (relating to general
payment policy).
(2) Transferred to
another hospital that is paid under the Pennsylvania MA DRG prospective payment
system.
(3) Treated as an inpatient
in the hospital continuously for 90 or more days.
(c) A hospital may not submit an invoice to the Department until a final determination of the recipient's eligibility for potential third-party payment has been made.
(d) Services and items provided to an inpatient shall be billed as hospital inpatient services except:
(1) Direct care services provided by a
practitioner as defined in Chapter 1101 (relating to general provisions) who is
under salary or contract with the hospital.
(2) Direct care services provided by a
midwife as defined in Chapter 1142 (relating to midwives' services) who is
under salary or contract with the hospital.
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