Mont. Admin. r. 37.85.1119

Current through Register Vol. 23, December 6, 2024

Rule 37.85.1119 - APPLICATION FOR PAYMENTS BY AN ELIGIBLE PROVIDER OR ELIGIBLE HOSPITAL

(1) An EP qualifying to receive payment must submit the following provider identification information:

(a) name;

(b) National Provider Identification Number (NPI);

(c) business address and phone number; and

(d) Taxpayer Identification Number (TIN).

(2) In addition to the information in (1), an EP practicing outside of a FQHC or RHC must certify or attest that:

(a) the EP is using a certified electronic health record;

(b) the EP meets the meaningful use requirement;

(c) the EP meets applicable patient volume thresholds and identifies the 90-day continuous reporting period of the previous calendar year;

(d) the EP furnished less than 90% of covered services in "place of service" codes 21 Inpatient, and 23 Emergency Room;

(e) in the first payment year, the EP must adopt, implement, upgrade, or demonstrate meaningful use over any continuous 90-day period in a calendar year; and

(f) during the second and subsequent years the EP must attest through submission of defined objectives and clinical quality measures use of the certified EHR.

(3) In addition to (1) an EP practicing in a FQHC or RHC must certify or attest that:

(a) the EP practices predominantly at an FQHC or RHC and that more than 50% of total patient encounters during a six-month period in the most recent calendar year occurred at the FQHC/RHC;

(b) the EP is using a certified EHR;

(c) the EP meets the meaningful use requirements; and

(d) the EP meets the needy patient volume threshold.

(4) An EH qualifying to receive payment must submit the following provider identification information:

(a) name;

(b) CMS Certification Number (CNN);

(c) National Provider Identifier (NPI); and

(d) Hospital Tax Identification Number.

(5) In addition to the information in (4), the EH must attest or certify that:

(a) the hospital is using a certified electronic health record;

(b) the average length of stay for patients at the facility is 25 days or fewer; and

(c) the hospital meets the 10% Medicaid Patient Volume threshold and identifies the associated 90-day continuous period for the federal fiscal year.

Mont. Admin. r. 37.85.1119

NEW, 2011 MAR p. 1374, Eff. 7/29/11.

53-6-113, MCA; IMP, 53-6-111, MCA;