Section 148.180  Payment for Pre-operative Days and Patient Specific Orders

Effective for dates of discharge on or after July 1, 2014:

a)         Pre-operative Days.  For hospitals and distinct part units reimbursed on a per diem basis under Sections 148.105, 148.110, 148.116, 148.160 or 148.170, payment for pre-operative days shall be limited to the day immediately preceding surgery unless the attending physician has documented the medical necessity of an additional day or days.  The documentation must be kept in the patient's medical record and must consist of a written notation made by the physician which documents that more than one pre-operative day is medically necessary.

b)         Ancillary Services and Tests

1)         Ancillary services and routine tests (those services other than routine room and board and nursing which are required because of the patient's medical condition, including lab tests and x-rays) shall not be covered unless there is a patient specific written order for the test from the attending or operating physician responsible for the care and treatment of the patient.  The attending or operating physician responsible for the care and treatment of the patient is required to sign all applicable sections for each test ordered in the appropriate place in the medical record.  The order must be legible and explain completely all services or tests to be performed. Standing orders are not acceptable.

2)         Upon completion of the service or test, a fully documented description of results with findings, or the administration of medication, must be maintained in the patient medical records.  Radiological services must have the actual x-rays and the interpretation report; laboratory/pathological tests must have the specific findings for each test; and drugs and pharmaceutical supplies must indicate strength, dosages and durations.

3)         Charges for any and all such services or tests cannot exceed those charged to the general public.  The failure to maintain and provide records as described in this Section shall result in the disallowance of the applicable charges upon audit.

(Source:  Amended at 38 Ill. Reg. 15165, effective July 2, 2014)