Current through September 2, 2024
Section 16.03.09.505 - PHYSICIAN SERVICES: PROVIDER REIMBURSEMENT01.Physician Penalties for Late QIO Review. Medicaid will assess the physician a penalty for failure to request a preadmission review from the Department, for procedures and diagnosis listed on the select list in the Department's Physician Provider Handbook and the QIO Idaho Medicaid Provider Manual. If a retrospective review determines the procedure was medically necessary, and the physician was late in obtaining a preadmission review the Department will assess a penalty according to Subsection 505.02 of this rule. The penalty will be assessed after payment for physician services has occurred.02.Physician Penalty Schedule.a. A request for preadmission QIO review that is one (1) day late will result in a penalty of fifty dollars ($50).b. A request for preadmission QIO review that is two (2) days late will result in a penalty of one hundred dollars ($100).c. A request for preadmission QIO review that is three (3) days late will result in a penalty of one hundred and fifty dollars ($150).d. A request for preadmission QIO review that is four (4) days late will result in a penalty of two hundred dollars ($200).e. A request for preadmission QIO review that is five (5) days late or later will result in a penalty of two hundred and fifty dollars ($250).03.Physician Excluded From the Penalty. Any physician who provides care but has no control over the admission, continued stay, or discharge of the patient will not be penalized. Assistant surgeons and multi-surgeons are not excluded from the penalty.Idaho Admin. Code r. 16.03.09.505