Ariz. Admin. Code § R9-22-712.45 - Outpatient Hospital Reimbursement: Outpatient Payment Restrictions
A.AHCCCS shall not
reimburse hospitals for emergency room treatment, observation hours, or other
outpatient hospital services performed on an outpatient basis if the member is
admitted as an inpatient to the same hospital directly from the emergency room,
observation, or other outpatient department.
B.AHCCCS shall include payment for the
emergency room, observation, and other outpatient hospital services provided to
the member before the hospital admission in the AHCCCS Inpatient Tiered Per
Diem Capped Fee-For-Service Schedule under Article 7 of this Chapter.
C.Same day admit and discharge.
1. For discharges before September 30, 2014.
Same day admit and discharge claims that qualify for either the maternity or
nursery tiers shall be paid based on the lesser of the rate for the maternity
or nursery tier, or the outpatient hospital fee schedule.
2. For discharge dates on and after October
1, 2014. Same day admit and discharge claims are paid for through the
outpatient fee schedule.
Notes
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