Inpatient/Outpatient Reimbursement Clarification

Date: 01/04/22

On behalf of the Louisiana Department of Health, Louisiana Healthcare Connections would like to provide clarification regarding inpatient/outpatient reimbursement claims payment. This clarification which will be included in an upcoming revision to the FFS Provider Manual.

24 Hour Rule for Inpatient/Outpatient Services

• Non-reimbursable:
  • Outpatient diagnostic services related to an inpatient admission performed either during or within 24 hours of inpatient admission regardless of hospital ownership.
  • The inpatient hospital is responsible for reimbursing the hospital providing the outpatient services. The inpatient hospital may reflect the outpatient charges on its claim.
• Exemptions to the above policy:
  • Outpatient therapy performed within 24 hours before an inpatient admission and 24 hours after the discharge. This includes outpatient services that are either related or unrelated to the inpatient stay.
  • Transfers from an emergency department to a different hospital/provider.

(If one of the above exceptions are met, separate billing and payment for the outpatient hospital service are allowed.)