PAYMENT PROCEDURES

Subpart 1. Submittal of claims. Claims may not be submitted to the department until after a patient is discharged or 30 days after admission and every subsequent 30 days, whichever occurs first. A hospital that submits a claim to the department after 30 days from admission, but before discharge, shall submit a final claim after discharge. Subp. 1a. Payor of last resort. A hospital may not submit a claim to the department until a final determination of the patient's eligibility for potential third party payment has been made by a hospital. Any and all available third-party benefits must be exhausted prior to billing medical assistance and the third-party liability amounts must be entered on the claim. Subp. 1b. Third-party liability. Payment for patients that are simultaneously covered by medical assistance and a third party will be determined according to a hierarchy of application as set out in items A to E. A. Medical assistance payment for a Medicare crossover will be determined by subtracting the third-party liability from the Medicare deductible and coinsurance due from the patient. A negative difference will not be implemented. B. Medical assistance payment for a Medicare crossover whose Medicare benefits either exhaust or begin during an admission will be determined by subtracting the Medicare payment and third-party liability from the medical assistance rate. A negative difference will not be implemented. C. Medical assistance payment will not be made for an admission when either charges are paid by a third party or the hospital has an agreement to accept payment for less than charges as payment in full. D. Medical assistance payment for an admission under item C that requires a deductible or coinsurance will be made at a level equal to the deductible or coinsurance due from the patient. E. Medical assistance payment for a patient with any third-party benefits will be determined as the lesser of the covered charges minus the third-party liability, or the medical assistance rate minus the third-party liability. A negative difference will not be implemented. Subp. 1c. Reduction of recipient resources. Recipient resources will also be reduced from the amounts in subpart 1b. Subp. 2. [Repealed, 18 SR 1115] Subp. 3. [Repealed, 18 SR 1115] Subp. 4. [Repealed, 18 SR 1115] Subp. 5. [Repealed, 18 SR 1115] Subp. 6. [Repealed, 18 SR 1115] Subp. 7. [Repealed, 18 SR 1115] Subp. 8. [Repealed, 18 SR 1115] Subp. 9. [Repealed, 18 SR 1115] Subp. 10. [Repealed, 18 SR 1115] Subp. 11. [Repealed, 18 SR 1115] Subp. 12. [Repealed, 18 SR 1115]