Practice Managers Manual - Irish Health Repository

Patients are deemed ineligible for payment for the following reasons:
Patient does not have a valid medical card or the card was withdrawn prior to the start of the scheme.
Patient is not over 70 years of age.
Patient is not a resident of a Nursing Home registered with the Health Service Executive .
Patient is not a long-term resident of the Nursing Home (ie: resident for 5 weeks or more since the 1 st July
2001).
Note: As per the terms of the agreement the capitation rate will apply to patients aged 70 or over in private nursing
homes (approved by the Health Service Executive) for continuous periods in excess of five weeks.
Therefore it should be noted that from the time a patient is coded in the Local Health Office retrospective payment will
be made 5 weeks following the date of coding.
Coding
Patients are coded in two different categories:
903 – A standard over 70’s medical card patient in a private nursing home (approved by the Health Service
Executive).
906 – An over 70’s patient with automatic medical card eligibility in a private nursing home (approved by the
Health Service Executive).
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