23 Miss. Code. R. 202-2.3 - Emergency Department Outpatient Visits
A. Emergency
department services, also referred to as emergency room services, are allowed
for all beneficiaries without limitations. Emergency department services
provided by hospitals, except for Indian Health Services (IHS), are reimbursed
using the outpatient prospective payment methodology.
B. The date of service for evaluation and
management procedure code line items for outpatient hospital emergency
department claims must be the date the beneficiary enters the emergency
department even if the beneficiary's encounter spans multiple dates of
service.
C. Services provided
during an emergency department visit resulting in an inpatient hospital
admission must be included on the inpatient hospital claim.
1. The "Statement Covers Period From Date" on
the inpatient hospital claim is the first date the beneficiary enters the
emergency department.
2. The
Treatment Authorization Number (TAN) on the inpatient hospital claim is
received from the Utilization Management and Quality Improvement Organization
(UM/QIO), the Division of Medicaid, or a designated entity which corresponds
with the date the physician documents the inpatient hospital admission in the
physician's orders.
a) A TAN is not required
for an emergency department visit.
b) A TAN issued by the UM/QIO, the Division
of Medicaid, or a designated entity is only required for an inpatient admission
or continued stay.
Notes
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