55 Pa. Code § 1163.63 - Billing requirements
(a) The
hospital shall submit invoices to the Department in accordance with the
instructions in the Provider Handbook.
(b) The hospital may not submit an invoice
until the recipient has been one of the following:
(1) Discharged from the hospital as defined
in §
1163.51 (relating to general
payment policy).
(2) Transferred to
another hospital that is paid under the Pennsylvania MA DRG prospective payment
system.
(3) Treated as an inpatient
in the hospital continuously for 90 or more days.
(c) A hospital may not submit an invoice to
the Department until a final determination of the recipient's eligibility for
potential third-party payment has been made.
(d) Services and items provided to an
inpatient shall be billed as hospital inpatient services except:
(1) Direct care services provided by a
practitioner as defined in Chapter 1101 (relating to general provisions) who is
under salary or contract with the hospital.
(2) Direct care services provided by a
midwife as defined in Chapter 1142 (relating to midwives' services) who is
under salary or contract with the hospital.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.