Page 203

UPDATED: AUGUST 1999

300

INCOME EXCESS

SIX-MONTH

(1) Determine the average private per diem rate by dividing the total private charges by the length of the stay (date of admission until, but not including, date of discharge); (2) Calculate the number of hospital days fully covered by the A/R’s liability by dividing the average private per diem rate into the patient liability;

(3) Apply the remaining liability, if any, to the next acute day. (a) If the remaining liability exceeds the Medicaid per diem, no portion of that day will be paid by Medicaid. Enter the following day in the Service FROM Date field on the Principal Provider Subsystem (PPS), the date of discharge as the Service TO Date, and enter zero in the Net Available Income (NAMI) field. (b) If the remaining liability is less than the Medicaid per diem rate, Medicaid will pay the difference between the remaining liability and the Medicaid per diem rate. Enter this day (commonly referred to as a "partial day") in the Service FROM Date field, the date of discharge as the Service TO Date, and enter the remaining liability in the NAMI field on PPS;

(4) Instruct the hospital to bill only for the days covered by Medicaid, and to enter the remaining liability, if any, in the surplus field of the claim form.

II. For hospital stays where the Medicaid payment rate is calculated utilizing DIAGNOSTIC RELATED GROUPS (DRG): (1) Determine the percentage of the hospital stay covered by the A/R’s liability by dividing the liability by the private pay charges;

(MRG)