Inpatient Hospital Services. HOSPITAL ADMISSIONS MUST BE AUTHORIZED OR APPROVED BY CAREFIRST BLUECHOICE, UNLESS EXCEPTIONS ARE STATED.
Inpatient Hospital Services. The Plan provides Benefits for the following Medically Necessary Inpatient Hospital services:
a. Room and board, including general nursing care, special duty nursing, and special diets, in a semiprivate room;
b. Use of intensive care or coronary care unit;
Inpatient Hospital Services. Except to the extent inconsistent with the rate methodology explained herein, VA shall reimburse at rates based on Medicare payment methodologies for services to Eligible AI/AN Veterans. The payment methodology under this section applies to all inpatient services furnished by the hospital, whether provided by part of a department, subunit, distinct part, or other component of a hospital (including services furnished directly by the hospital or under arrangements with contract providers who provide Direct Care Services onsite in an IHS or Tribal health facility).
1. Payment for hospital services that the Medicare program would pay under a prospective payment system (PPS) will be based on the applicable PPS. For example, payment for inpatient hospital services shall be made per discharge based on the applicable PPS used by the Medicare program to pay for similar hospital services under 42 C.F.R. Part 412.
2. For hospitals that furnish inpatient services but are exempt from PPS and receive reimbursement based on reasonable costs (for example, critical access hospitals (CAHs)), including provider subunits exempt from PPS, payment shall be made per discharge based on the reasonable cost methods established under 42 C.F.R. Part 413, except that the interim payment rate under 42 C.F.R. Part 413, subpart E shall constitute payment in full.
3. The inpatient rates set forth above do not include inpatient physician services and practitioner services. The inpatient physician and other practitioner services shall be billed based on the Medicare fee schedule.
Inpatient Hospital Services. See the Prior Authorization Amendment for Covered Services that may require prior authorization. .
Inpatient Hospital Services. 1a. Inpatient Stay Pending Alternate Level of Medical Care
Inpatient Hospital Services. The MCOP shall enforce the three-calendar day roll-in requirements as described in OAC rule 5160-2-02.
Inpatient Hospital Services. HOSPITAL ADMISSIONS MUST BE AUTHORIZED OR APPROVED BY CAREFIRST UNLESS EXCEPTIONS ARE STATED.
Inpatient Hospital Services. Inpatient hospital services, as medically necessary, shall include, except as otherwise specified, the care, treatment, maintenance and nursing services as may be required, on an inpatient hospital basis, up to 365 days per year (366 days in leap year). Contractor will not be responsible for hospital stays that commence prior to the Effective Date of Enrollment (see Section 6.8 of this Agreement), but will be responsible for stays that commence prior to the Effective Date of Disenrollment (see Section 8.5 of this Agreement). Among other services, inpatient hospital services encompass a full range of necessary diagnostic and therapeutic care including medical, surgical, nursing, radiological, and rehabilitative services. Services are provided under the direction of a physician, certified nurse practitioner, or dentist.
Inpatient Hospital Services. The benefit package includes hospital inpatient acute care, procedures, and services asset forth in MAD Program Manual section MAD-721, HOSPITAL SERIVCES. The CONTRACTOR shall comply with the maternity length of stay in the Health Insurance Portability and Accounting Act of 1996. Coverage for a hospital stay following a normal vaginal delivery may generally not be limited to less than 48 hours for both the mother and newborn child. Health coverage for a hospital stay in connection with childbirth following a cesarean section may generally not be limited to less than 96 hours for both mother and newborn child.
Inpatient Hospital Services. Coverage for Inpatient Hospital services shall not exceed the actual semi-private room rate, unless a private room is determined to be Medically Necessary by the MCO.
