Refac

This rejection applies to the additional fee for nursing care if repeat dispensations (428035, 428050, 428072) are inconsistent with statistical records (R 50 Z 3 = 9).

If there is that day:

• a provision is 428035, 428050 or 428072, there must be at least a third basic provision;
• two provisions are 428035, 428050 or 428072, there must be at least a third and a fourth basic provision;
• three provisions are 428035, 428050 or 428072, there must be at least a third, a fourth and a fifth basic provision.

In addition, the care provider for the 428035, 428050 and 428072 provisions must be the same as for the basic provision.

The legal basis of this rejection is Article 8, §5quater:
'Provisions 428035, 428050 and 428072 can be certified for the 3rd, 4th and 5th visit to the same patient on the same care day for heavily care-dependent patients who benefit from a provision described in §1, 1°, II and IV, in §1, 2°, II and IV and in §1, 3°, II except for benefits 427173 and 427195. Only the care provider who actually performs the third or subsequent visits can charge for this benefit. This provision can be charged a maximum of once per care day for the 3rd visit, a maximum of once per care day for the fourth visit and a maximum of once per care day for the fifth visit.'