South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:06.15 - Rate of payment - Medicare crossover claims for certain inpatient hospital services

If the department receives a Medicare crossover claim for an inpatient hospital stay and the hospital is subject to the DRG rate of payment, the department shall calculate the DRG payment for the claim based on the date of service. If the amount paid by Medicare is greater than the calculated DRG amount, the department considers the claim to be paid in full and no additional payment will be made by the department. If the amount paid by Medicare is less than the calculated DRG amount, the department shall reimburse the difference between the two payment amounts up to the Medicare inpatient deductible.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Basis of reimbursement -- Inpatient services -- Hospitals with more than 30 Medicaid discharges, § 67:16:03:06.