Update to Acute Inpatient Hospital Services Clinical Policy 2A-1

Medicaid has been made aware of reimbursement delays when claims for medical services are billed for inpatient services with a psychiatric diagnosis as the primary diagnosis.

The following clarifications were added to the policy in Attachment B, Behavioral Health Claims:

• Submit claims to the Prepaid Inpatient Health Plan (PIHP) for reimbursement when a Medicaid beneficiary is receiving psychiatric care in a general hospital, with a psychiatric Diagnosis Related Group (DRG), while waiting for an inpatient psychiatric bed.
• Refer to clinical coverage policy 8B, Inpatient Behavioral Health Services, at https://dma.ncdhhs.gov for behavioral health coverage criteria and billing information for inpatient services in an inpatient psychiatric facility, or in a psychiatric unit of a general hospital for Medicaid beneficiaries.

Additionally, the following clarifications were added:

• In Attachment B, a revision was made to the list of hospitals exempt from the Present on Admission/Hospital-Acquired Conditions indicator to align with Centers for Medicare & Medicaid Services.
• In Attachment C, a requirement was added to include a hospital’s license number (that is assigned by the Department of Health and Human Services’ Division of Health Service Regulation) on a Utilization Review Plan.