37.86.2904 INPATIENT HOSPITAL SERVICES, BILLING REQUIREMENTS

(1) Inpatient hospital service providers shall be subject to the billing requirements set forth in ARM 37.85.406. At the time a claim is submitted, the hospital must have on file a signed and dated acknowledgment from the attending physician that the physician has received the following notice: "Notice to physicians: Medicaid payment to hospitals is based on all of each patient's diagnoses and the procedures performed on the patient, as attested to by the patient's attending physician by virtue of his or her signature in the medical record. Anyone who misrepresents, falsifies or conceals essential information required for payment of federal funds, may be subject to fine, imprisonment or civil penalty under applicable federal laws."

(2) The acknowledgment must be completed by the physician at the time that the physician is granted admitting privileges at the hospital, or before or at the time the physician admits his or her first patient to the hospital.

(3) Existing acknowledgments signed by physicians already on staff remain in effect as long as the physician has admitting privileges at the hospital.

(4) The provider may, at its discretion, add to the language of this statement the word "Medicare" so that two separate forms will not be required by the provider to comply with both state and federal requirements.

(5) Except for hospital resident cases, a provider may not submit a claim until the recipient has been either:

(a) discharged from the hospital;

(b) a patient at least 30 days, in which case the hospital may bill on the 31st day and every 30 days thereafter;

(d) designated by the department as a hospital resident as set forth in ARM 37.86.2921.

(6) Cost based hospitals may split bill at their fiscal year end.

(7) Medical records must be received within 30 days of request by the department or the department's designated review organization.

(a) Claims may be denied if the receipt of the medical records exceeds the designated time period.

History: 2-4-201, 53-2-201, 53-6-113, MCA; IMP, 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 2849, Eff. 11/10/06; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10.