Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter B - HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES
PAYMENT FOR COST REIMBURSED HOSPITAL SERVICES
Section 1163.456 - Third-party liability
Current through Register Vol. 54, No. 44, November 2, 2024
In addition to the conditions set forth in Chapter 1101 (relating to general provisions) the following policies apply to third-party resources for hospital services:
(1) Sources of payment other than MA shall be researched prior to billing the Department. If a resource is found, it shall be depleted to the full extent of the liability of that resource prior to billing MA. Lifetime reserve days under Medicare are considered an available resource.
(2) If the hospital receives payment from a third party subsequent to payment from the Department, repayment to the MA Program shall be made by way of a claim adjustment.
This section cited in 55 Pa. Code § 1163.451 (relating to general payment policy); and 55 Pa. Code § 1163.457 (relating to payment policies relating to out-of-State hospitals).
