If the department receives a medicare crossover claim for an inpatient hospital stay and the hospital is subject to the diagnosis-related group (DRG) rate of payment, the department must calculate the DRG payment for the claim based on the date of service. If the amount paid by medicare is greater than the calculated DRG amount, the department considers the claim to be paid in full and no additional payment is to be made by the department. If the amount paid by medicare is less than the calculated DRG amount, the department must reimburse the difference between the two payment amounts up to the medicare inpatient deductible.

Basis of reimbursement -- Inpatient services -- In-state hospitals, § 67:16:03:06.

Source: 28 SDR 3, effective August 1, 2001 ; 52 SDR 126, effective July 1, 2026 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 .

Prior versions effective: 2001-08-01.