471 NAC 21-004. Billing and Payment for Chiropractic Services

21-004 Billing and Payment for Chiropractic Services 21-004.01 Billing 21-004.01A General Billing Requirements: Providers shall comply with all applicable billing requirements codified in 471 NAC Chapter 3. In the event that billing requirements in 471 NAC Chapter 3 conflict with billing requirements outlined in this 471 NAC Chapter 21, the billing requirements in 471 NAC Chapter 21 shall govern. 21-004.01B Specific Billing Requirements 21-004.01B1 Billing Instructions: The provider shall bill Medicaid in accordance with the billing instructions included in this Chapter. 21-004.02 Payment 21-004.02A General Payment Requirements: Medicaid will reimburse the provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC Chapter 3. In the event that payment regulations in 471 NAC Chapter 3 conflict with payment regulations outlined in this 471 NAC Chapter 21, the payment regulations in 471 NAC Chapter 21 shall govern. 21-004.02B Specific Payment Requirements 21-004.02B1 Payment for Inpatient Care: All rehabilitation services, regardless of the type of hospital providing the service, will be reimbursed on a per diem basis. This includes services provided at a facility enrolled as a provider for rehabilitation services which is not a licensed rehabilitation hospital or a Medicare-certified distinct part unit. The per diem rate will be the sum of the following: 1. The hospital-specific base payment per diem rate (See Appendix 471-000-82, Inpatient Hospital Services, Section III.A.1); 2. The hospital-specific capital per diem rate (See Appendix 471-000-82, Inpatient Hospital Services, Section III.A.2); and 3. If applicable, the hospital's direct medical education per diem rate (See Appendix 471-000-82, Inpatient Hospital Services, Section III.A.3). Payment for each discharge equals the per diem rate times the number of approved patient days. Payment is made for the day of admission but not for the day of discharge. 21-004.02B2 Payment for Outpatient Hospital and Emergency Room Services: See 471 NAC 10-010.06, Payment for Outpatient Hospital and Emergency Room Services.