SECTION 317:30-5-113. Medicare eligible individuals

  Payment is made to hospitals for services to Medicare eligible individuals as set forth in this section.

(1)   Individuals eligible for Part A and Part B.

(A)   Payment is made utilizing the Medicaid allowable for comparable Part B services.

(B)   Payment is made for the coinsurance and/or deductible for Part A services for categorically needy individuals.

(2)   Individuals who are not eligible for Part A services.

(A)   The Part B services are to be filed with Medicare. Any monies received from Medicare and any coinsurance and/or deductible monies received from OHCA must be shown as a third party resource on the appropriate claim form for inpatient per diem. The inpatient per diem should be filed with the fiscal agent along with a copy of the Medicare Payment Report.

(B)   For individuals who have exhausted Medicare Part A benefits, claims must be accompanied by a statement from the Medicare Part A intermediary showing the date benefits were exhausted.

[Source: Added at 23 Ok Reg 239, eff 10-3-05 (emergency); Added at 23 Ok Reg 1346, eff 5-25-06]