§ 1163.63. Billing requirements.
(a) The hospital shall submit invoices to the Department in accordance with the instructions in the Provider Handbook.
(b) The hospital may not submit an invoice until the recipient has been one of the following:
(1) Discharged from the hospital as defined in § 1163.51 (relating to general payment policy).
(2) Transferred to another hospital that is paid under the Pennsylvania MA DRG prospective payment system.
(3) Treated as an inpatient in the hospital continuously for 90 or more days.
(c) A hospital may not submit an invoice to the Department until a final determination of the recipient’s eligibility for potential third-party payment has been made.
(d) Services and items provided to an inpatient shall be billed as hospital inpatient services except:
(1) Direct care services provided by a practitioner as defined in Chapter 1101 (relating to general provisions) who is under salary or contract with the hospital.
(2) Direct care services provided by a midwife as defined in Chapter 1142 (relating to midwives’ services) who is under salary or contract with the hospital.
Source The provisions of this § 1163.63 adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185; amended June 1, 1990, effective retroactively to July 1, 1988, 20 Pa.B. 2913. Immediately preceding text appears at serial page (90734).
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