Inpatient Census Reporting Requirements
Options to fulfill this requirement include:
Failure to Submit an ICR
Section 3. Hospital Reporting Requirements.
(a) A hospital is not entitled to receive the full Medicaid allowable payment for covered services furnished to a client unless the hospital has reported the client to the Department on an Inpatient Census Report (“ICR”), subject to the following provisions:
(i) A hospital shall submit an ICR to the Department by 5:00 p.m. on Friday of each week.
(ii) An ICR must:
(A) Be submitted electronically in the form and manner established by the Department; and
(B) Report each client admitted to the hospital since the last ICR deadline.
(iii) If a hospital fails to timely report a client on an ICR, the hospital may not report the client on a subsequent ICR unless the client has not yet been discharged from the hospital.
(iv) If a hospital makes a late report of a client on an ICR, the Department may reduce, by up to twenty-five percent (25%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.
(v) If a hospital altogether fails to report a client on an ICR, the Department may reduce, by up to one hundred percent (100%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.
(vi) If a hospital makes a late report of a client on an ICR late or altogether fails to report a client on an ICR and, nonetheless, the Department pays the hospital the full Medicaid allowable payment, the Department may recoup the overpayment pursuant to the procedures under Chapter 3 of Rules, Wyoming Department of Health, Medicaid (“the Medicaid Rules”).
(b) If a client is determined eligible for Medicaid only after discharge from the hospital, then the Medicaid allowable payment to the hospital shall not be reduced for failure to include that client on prior ICRs.