55 Pa. Code § 1126.82 - Administrative sanctions
(a) If the
ASC/SPU quality assurance/utilization review committee fails to review a
Medical Assistance recipient's need for admission or fails to request approval
for the admission through the Department's Bureau of Policy and Program
Development, the Department will deny payment for the stay.
(b) If the Department determines that a
facility billed for services inconsistent with this chapter and Chapter 1101
(relating to general provisions), provided incorrect information on the billing
invoice regarding a patient's diagnosis or procedures performed, the Department
will deny payment for the claims.
(c) If the Department determines that an
ASC/SPU claim has been inappropriately coded based on information in the
patient's medical record or discovers coding errors, the Department will
correct the claim for payment purposes.
Notes
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