Minnesota Administrative Rules
9500.1130 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.
History:
10 SR 227; 10 SR 867; 11 SR 1688; 13 SR 1689; 18 SR 1115
Published Electronically:
October 16, 2013
Official Publication of the State of Minnesota
Revisor of Statutes