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Tuesday, April 12, 2011

Does hospital need to maintain the records of patient?

Are hospitals required to keep paper copies of attachments related to physicians’ inpatient services, e.g. Second Surgical Opinion Form, Sterilization Consent form, etc.?

Yes. The hospital must maintain a paper copy of these forms in the patient’s permanent file.
Is the inpatient hospital per diem rate based on the date of admission or the date of service when there is a rate change?

The per diem rate is based on the date of admission.

A hospital receives certification for a patient admission and admits the patient. Later in the admission day, the patient has to be transferred to another facility which also needs certification. How is this processed and how would the services be billed?

The MO HealthNet Hospital Provider Manual, Section 13.30.B - DAY OF DISCHARGE, DEATH, OR TRANSFER states: “MO HealthNet reimburses a facility for the day of admission. MO HealthNet does not cover the day of discharge, death or transfer unless it also is the day of admission and then it is reimbursable. The costs for the day of discharge, death or transfer cannot be billed to the recipient.”

In the example above, both facilities must obtain certification from Health Care Excel (HCE). Whichever facility submits a properly completed claim to MO HealthNet first should receive reimbursement. The facility that submits a claim to MO HealthNet second will have its claim denied as a duplicate unless a completed Certificate of Medical Necessity (CMN) is submitted with the claim to justify the care on the same date of service. It is advisable, however, for both facilities to submit a completed Certificate of Medical Necessity with their claims to avoid a duplicate service denial. The Certificate of Medical Necessity can be submitted electronically through the MO HealthNet Internet billing Web site, emomed.com, as an attachment to the electronic claim by clicking on the "Add Header Medical Necessity" link at the bottom of the claim page.

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