<html> <head> <title>Rule 67:16:03:06.15 Rate of payment -- Medicare crossover claims for certain inpatient hospital services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:03:06.15"> <META NAME="Description" Content="Administrative Rules 67:16:03:06.15 Rate of payment -- Medicare crossover claims for certain inpatient hospital services."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:03:06.15.&nbsp;&nbsp;Rate of payment -- Medicare crossover claims for certain inpatient hospital services.</b> If the department receives a Medicare crossover claim for an inpatient hospital stay and the hospital is subject to the DRG rate of payment, the department shall calculate the DRG payment for the claim based on the date of service. If the amount paid by Medicare is greater than the calculated DRG amount, the department considers the claim to be paid in full and no additional payment will be made by the department. If the amount paid by Medicare is less than the calculated DRG amount, the department shall reimburse the difference between the two payment amounts up to the Medicare inpatient deductible.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 28 SDR 3, effective August 1, 2001.</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Basis of reimbursement -- Inpatient services -- Hospitals with more than 30 Medicaid discharges, §&nbsp;67:16:03:06.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>