S.D. Admin. R. 67:16:05:07.01
A claim submitted for services provided under this chapter must be submitted at the provider's usual and customary charge and must contain the applicable procedure codes contained on the department's website for covered home health services.
If a registered nurse or a licensed practical nurse performs a home health aide service, the service must be billed as a home health aide service.
If two or more persons of the same discipline simultaneously provide a single service, it is counted as one service and must be billed as a single service.
Skilled nursing or aide visits requiring additional staff to provide the care which is an integral part of one visit must be billed with a modifier "22". The medical record must contain documentation verifying that the claimed service was authorized by the attending physician or other licensed practitioner and was actually provided.
When billing services under this chapter, the provider must include the number of 15-minute units of time spent delivering the needed service.
Except for an electronic claim, if the individual is covered by Medicare or private health insurance, a copy of the denial or evidence of payment from Medicare or the insurance carrier must accompany the claim. For an electronic claim, the provider shall maintain and submit to the department on request evidence of claim payments or rejection.
S.D. Admin. R. 67:16:05:07.01
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(1)(2).
Third-party liability, ch 67:16:26.