55 Pa. Code § 1230.42 - Ongoing responsibilities of providers
Current through Register Vol. 51, No. 52, December 25, 2021
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§ 1230.42.Ongoing responsibilities of providers.
(a) Providers shall meet the ongoing responsibilities of this section in addition to the ongoing responsibilities established in § 1101.51 (relating to ongoing responsibilities of providers).
(b) State and Federal officials or their authorized agents may conduct onsite reviews in order to verify information furnished as a basis for payment under the MA Program and to establish the provider’s usual and customary charge to the general public, as defined in Chapter 1101 (relating to general provisions). Reviews shall be conducted during normal hours of operation or at a time mutually agreeable to the officials and the providers. During the course of the review, the provider shall ensure that the reviewers have access to, and are permitted to photograph, photocopy or duplicate:
(1) X-ray films and reports of studies performed and billed to the Department.
(2) Procedure manuals, records and documents necessary to determine whether payment for services is or was due under the program and whether services are or were provided in compliance with State and Federal law.
(c) X-rays performed and billed to the Department shall be of good technical and diagnostic quality. The provider shall properly label each X-ray film to indicate:
(1) The patient’s name.
(2) The date of service.
(3) The type of view.
(4) Right or left side.
The provisions of this § 1230.42 adopted August 13, 1982, effective August 14, 1982, 12 Pa.B. 2688.