Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter A - PURCHASED HEALTH SERVICES › Division 6 - HOSPITAL SERVICES › Section 354.1071 - Additional Claim Information Requirements

Current through Reg. 49, No. 28; July 12, 2024
In addition to the general requirements in §
											RSA
						354.1001 of this subchapter (relating to
						Claim Information Requirements), HHSC requires that the following information
						be submitted with hospital claims:
(1)
					 Inpatient hospital care.
(A) Copy of the
					 patient's itemized daily charges, including data elements and format as
					 specified by HHSC.
(B) Date and
					 hour of admission and discharge, including inclusive dates during which
					 services were provided if claims are made for a period other than that
					 beginning on the date of admission and ending with the date of
					 discharge.
(C) Number of days of
					 care.
(D) Charges for bed, meals,
					 and nursing care.
(E) Admitting
					 diagnoses or symptoms.
(F)
					 Discharge diagnoses (or diagnoses at end of period for which a claim is made if
					 discharge has not occurred).
(G)
					 Surgical procedures, if any.
(H)
					 Individual charges for ancillary services approved by HHSC.
(I) Dates on which the various types of
					 services were provided. The posting date is satisfactory except when a portion
					 of the period of care precedes or succeeds the certified period of eligibility.
					 In such cases, record the actual date that each of the types of services listed
					 in this paragraph was provided.
(J)
					 Certification by the hospital that the hospital has on file a record that
					 services provided were upon order of a physician or doctor, a record of
					 admission, continued stay certification, extension recertification, and 60-day
					 recertification.
(K) The hospital's
					 medical record number.
(L) The
					 name, address, and appropriate identification number of the attending physician
					 and, if appropriate, consulting physician(s) or doctor(s).
(M) The certification portion of the Texas
					 Admissions and Review Program (TARP) abstract must accompany claims from all
					 certified hospitals. The entire abstract must accompany claims from
					 noncertified hospitals.
(N) For
					 medically necessary hysterectomies, a patient's acknowledgment statement that
					 the person who secured authorization to perform the hysterectomy has informed
					 the patient and her representative, if any, orally and in writing, that the
					 hysterectomy renders the patient permanently sterile. The patient or her
					 representative, if any, must sign the written acknowledgment of receipt of that
					 information before the surgery. The provider must submit an acknowledgment
					 statement with hospital claims for hysterectomies unless the patient is sterile
					 at the time of the hysterectomy, or the patient requires a hysterectomy on an
					 emergency basis because of a life-threatening situation and the physician
					 determines that prior acknowledgment is not possible. If one of the exceptions
					 applies, the physician performing the hysterectomy must certify in writing, to
					 HHSC or its designee, that the specific circumstance existed at the time he or
					 she operated.
(O) Present on
					 admission indicators are required for all inpatient claims.