KS

A state pays a hospital inpatient per diem Medicaid rate but caps that rate at 10 days for a given service. However, the patient stays in the hospital for 4 more days and it is medically necessary. Should those additional days be included in uninsured or Medicaid? We believe the 4 additional days should be Medicaid since they are Medicaid-eligible and the service is a Medicaid covered service under the state plan. It is no different than the Medicare DRG payment system that pays a set amount no matter how many days a service actually takes (a Medicare DRG payment may be based on 10 days but the service took 14 days - in that case Medicare still recognizes 14 days on the cost report and PS&R). Now, let's assume this is private insurance and the same scenario occurs. If it is private insurance, can we include the 4 additional days as uninsured or is the patient insured?