4812.1 DHCF shall deny claims for Medicaid reimbursement arising out of a patient admission and discharge on the same date (same-day discharge); and shall instruct the billing provider to bill the services as outpatient services.

4812.2 DHCF shall deny Medicaid reimbursement for same-day discharges unless the patient status indicates death.

4812.3 DHCF shall identify a discharge as a one-day stay when the discharge date occurs on the day following the admission date.

4812.4 DHCF may reimburse a one-day stay as follows:

(a) A claim reflecting a one-day stay may be reimbursed as a hospital stay, but may be subject to post-payment review of the medical necessity of the admission; or

(b) A one-day stay may qualify for a low-cost outlier adjustment pursuant to the low-cost outlier.

4812.5 DHCF shall deny any claim for an inpatient stay that includes ineligible days.

4812.6 A denied claim may be resubmitted for eligible days.

SOURCE: Final Rulemaking published at 45 DCR 4141, 4151 (June 26, 1998); as amended by Emergency and Proposed Rulemaking published at 57 DCR 2691 (March 26, 2010) [EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 6837 (July 10, 2010) [EXPIRED]; as amended by Final Rulemaking published at 58 DCR 4323, 4332 (May 20, 2011); as amended by Final Rulemaking published at 59 DCR 15078 (December 28, 2012); as amended by Final Rulemaking published at 63 DCR 5234 (April 8, 2016).