55 Pa. Code § 1163.78b - Review requirements for cost outliers

(a) If a hospital intends to apply for an outlier payment on the basis of the hospital stay's qualifying as a cost outlier, the hospital utilization review committee or its representative shall review the services provided to the recipient to determine medical necessity.

(b) The utilization review committee or its representative shall identify services provided to the recipient listed as noncompensable services and items and services provided during noncompensable outlier days as specified under § 1163.59 (relating to noncompensable services, items and outlier days).

Notes

55 Pa. Code § 1163.78b

The provisions of this § 1163.78b adopted June 22, 1984, effective 7/1/1984, 14 Pa.B. 2185.

This section cited in 55 Pa. Code § 1163.73 (relating to hospital utilization review plan); and 55 Pa. Code § 1163.75 (relating to responsibilities of the hospital utilization review committee).