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 1163.458 - Payment policies relating to same-calendar-day admissions and discharges
Current through Register Vol. 54, No. 44, November 2, 2024
(a) The Department pays for inpatient stays consisting of an admission with subsequent discharge during the same calendar day.
(b) The services must be provided under this chapter.
(c) The interim payment rate is based on 50% of the inpatient per diem rate on file determined in this chapter.
(d) Payment for ancillary services provided to patients during same- calendar-day stays are included in the interim payment. The hospital may not submit a separate bill for these services.
(e) For auditing purposes each same-calendar-day admission and discharge will be counted as 1/2 day.
(f) Without exception same-calendar-day stays, regardless of the reason for the stay, are subject to §§ 1163.471-1163.481 (relating to utilization control) and will be reimbursed only if provided under this section.
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).
