This bulletin serves to provide clarification on coverage under NC Medicaid Clinical Coverage Policy 2A-1, Acute Inpatient Hospital Services as to the reimbursement for observation services. This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.
Policy 2A-1, Section 3.2.1.b states that a beneficiary in hospital observation status “for more than 30 hours shall either be discharged by the attending physician or converted to inpatient status by written order of the physician to receive continued Medicaid reimbursement beyond the 30 hours.”
To read the full Policy 2A-1, please visit the Program Specific Clinical Coverage Polices webpage, where you can find Policy 2A-1 under Facility Services.
For more information on hospital observation billing in NC Medicaid Direct, see the Reporting Hospital Observation Hours Fact Sheet under Claims Submission on the NCTracks User Guides & Fact Sheets webpage.
For more information on hospital observation billing in NC Medicaid Managed Care, please reach out directly to the NC Medicaid Managed Care health plans.
Contact
NCTracks Call Center: 800-688-6696
For NC Medicaid Managed Care questions, please contact the health plans.