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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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 [Repealed, 18 SR 1115]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]