|
• |
Psychiatric, rehabilitation, and chemical
dependency (substance abuse) services will be
excluded from payment by DRG rates. These
services will be paid using per diem payment
rates. |
| • |
Ambulance and air transportation services are
excluded from DRG payments. |
| • |
Bills assigned to a DRG that is defined as
ungroupable will be denied. |
| • |
Bills where the principal diagnosis is invalid as
a discharge diagnosis will be denied. |
| • |
Bills where the injured worker has been
admitted and discharged in less than
twenty-four hours will be reviewed by the
department and may be paid as hospital
outpatient services. |
| • |
The department may choose to exclude other
DRGs from DRG payment rates due to
concerns about access, case volume or other
considerations. These services will be paid
using the applicable percent of allowed charges
(POAC) factor and per diem rates. |