Medicaid reimbursement denied due to untimely preauthorization code change.

Topic: Health Law, Decided by: Judge Woodard 
Docket Number: 1328857  , Decision Date: April 15, 2013 
Attachment: Click here to download the decision. 

Petitioner, a hospital, appeals Respondent’s decision to deny its claim for Medicaid coverage of an inpatient medical procedure it performed on a patient in its facility. The patient had originally been scheduled for an outpatient procedure and the procedure had been coded as such. Petitioner failed to request an update in the precertification code within thirty days of the change in procedure from outpatient to inpatient services, as required by the Hospital Services Manual. Because the request for an authorization code change was untimely, the Department’s decision was affirmed.

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