Reimbursement denied where provider failed to document that inpatient services met program criteria.

Topic: Health Law, Decided by Judge Brown 
Docket Number: 1450910 , Decision Date: 2014-12-23 
Attachment: Click here to download the decision. 

Crisp Regional Hospital, a Medicaid-enrolled provider, did not document the medical necessity of services provided to a patient in its care.  Specifically, the hospital did not write on “utilization review notes” that the patient met “severity of illness or intensity of service” criteria for the dates of hospitalization.  Accordingly, it did not meet Georgia Medicaid prerequisites to receive reimbursement for the services provided to that patient.