- (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).
Source
The provisions of this § 1163.78b adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185.
Cross References
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).