10A NCAC 22G .0209. BILLING STANDARDS

(a)  Providers shall use codes from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD‑9‑CM) to report diagnoses and procedures.  This material is hereby incorporated by reference including any subsequent amendments and editions and is available for inspection at the Division of Medical Assistance, 1985 Umstead Drive, Raleigh, NC.  Copies may be obtained from the American Medical Association, 515 North State Street, Chicago, IL 60610 at a cost of fifty nine dollars and ninety five cents ($59.95).  Tel: 800‑621‑8335.  Providers shall use the codes which are in effect at the time of discharge.  The reporting of ICD‑9‑CM diagnosis and procedure codes shall follow national coding guidelines promulgated by the Health Care Financing Administration.

(b)  Providers shall generally bill only after discharge.  However, interim billings may be submitted on or after 60 days after an admission and on or after every 60 days thereafter.

(c)  The discharge claim is required for Medicaid payment.  The purpose of this Rule is to assure a discharge status claim is filed for each Medicaid stay.

(1)           An interim billing must be followed by a successive interim billing or discharge (final) billing within 180 days of the date of services on the most recent claim.  When an interim claim is not followed by an additional interim or discharge (final) claim within 180 days of the "to date of services" on the most recent paid claim, all payments made for all claims for the stay will be recouped.

(2)           After a recoupment is made according to this Rule, a subsequent "admit through discharge" or interim claim for payment will be considered for normal processing and payment unless the timely filing requirements of 10A NCAC 22B .0104 are exceeded.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; 42 C.F.R. 447, Subpart C;

Eff. February 1, 1995.