Revalidating medicare enrollment

(B) A medical service is not reimbursable if:(1) The service is charged to medicaid at a rate greater than the provider's usual and customary charge to other patients.(a) Inpatient hospital services billed by hospitals reimbursed on a prospective payment basis, as defined in Chapter 5101:3-2 of the Administrative Code, will not pay, in the aggregate, more than the provider's customary and prevailing charges for comparable services.

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(5) "Incidental contact" means contact with the information that is secondary or tangential to the primary purpose of the activity that resulted in the contact.

(7) "Information owner" means the individual appointed in accordance with division (A) of section 1347.05 of the Revised Code to be directly responsible for a system.

(8) "Interconnection of Systems" Refers to a linking of systems that belong to more than one agency, or to an agency, and other organization , which linking of systems results in a system that permits each agency or organization involved in the linking to have unrestricted access to the systems of the other agencies and organizations. (10) "Personal information" has the same meaning as defined in division (E) of section 1347.01 of the Revised Code.

(C) Conditions of medical necessity are met if all the following apply:(1) Meets generally accepted standards of medical practice; (2) Clinically appropriate in its type, frequency, extent, duration, and delivery setting; (3) Appropriate to the adverse health condition for which it is provided and is expected to produce the desired outcome; (4) Is the lowest cost alternative that effectively addresses and treats the medical problem; (5) Provides unique, essential, and appropriate information if it is used for diagnostic purposes; and (6) Not provided primarily for the economic benefit of the provider nor for the convenience of the provider or anyone else other than the recipient.

(D) The fact that a physician, dentist or other licensed practitioner renders, prescribes, orders, certifies, recommends, approves, or submits a claim for a procedure, item, or service does not, in and of itself make the procedure, item, or service medically necessary and does not guarantee payment for it.

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