Section 7 AAC 140.325 - Billing for hospital services(a) The quality improvement organization (QIO) certification of necessity for hospital stays over three days or for stays for treatment or procedures on the Select Diagnoses and Procedures Pre-certification List, adopted by reference in 7 AAC 160.900, must appear on the invoice submitted by the hospital in order to receive payment. The department will pay only for days that are medically necessary and within the scope of Medicaid coverage. If a recipient refuses to leave the hospital at the end of a covered stay, the hospital may bill the recipient for days beyond the noncovered or noncertified portion of the hospital stay. Payment by the department for covered services is considered by the department to be payment in full for those covered services.(b) When a health care-acquired condition or provider-preventable condition described in 7 AAC 140.315(e) is not present on admission, but is reported as a diagnosis associated with the hospitalization, the hospital must submit a claim identifying the condition, even if the hospital does not seek reimbursement for the hospitalization.Eff. 2/1/2010, Register 193; am 3/19/2014, Register 209, April 2014Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040