Kan. Admin. Regs. § 30-10-20 - Payment of claims
(a) Payment to
participating providers. Each participating provider shall be paid, at least
monthly, a per diem rate for nursing facility services, excluding resident
liability, rendered to eligible residents if all of the following conditions
are met:
(1) The agency is billed on the
paper claim form or electronic claim submission furnished by the contractor
serving as the fiscal agent for the medicaid/medikan program.
(2) The paper claim form or electronic claim
submission is verified by the administrator of the facility or a designated key
staff member.
(3) The claim is
filed no more than 12 months after the time the services were rendered pursuant
to K.S.A.
39-708a, and amendments thereto.
(4) The claim does not include services for
the date of discharge.
(b) Resident's liability. The resident's
liability for services shall be the amount determined by the local agency
office in which a medicaid/medikan resident or the resident's agent applies for
care. The resident's liability begins on the first day of each month and shall
be applied in full before any liability incurred by the medicaid/medikan
program. The unexpended portion of the resident's liability payment shall be
refunded to the resident or to the resident's agent if the resident dies or
otherwise permanently leaves the facility. Providers shall not charge fees or
finance charges related to late payment of resident liability.
(c) The payment of claims may be suspended if
there has been an identified overpayment and the provider is financially
insolvent.
(d) This regulation
shall be effective on and after May 1, 2005.
Notes
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