{"ref":"CA-HSP-FIN-01","title":"Insurance, Billing Integrity, Continuation of Care and Notices to Medicare","category":"Business","summary":"Covers the Agency's financial duties: the liability and workers' compensation insurance stated for licensure, paying licensing fees on time, never reducing care because a Medicare or Medi-Cal patient cannot pay, telling patients about cost-sharing, filing Notices of Election and termination within 5 calendar days, managing the Medicare aggregate cap, billing accurately and returning overpayments.","inShort":["The Agency never reduces or stops a patient's care because the patient cannot pay.","The Notice of Election is filed with Medicare within 5 calendar days of the election.","Notices of discharge or revocation are filed within 5 calendar days.","Bill only for care that was given and documented, at the level of care the record supports.","Tell the Administrator about any billing error so overpayments are returned within 60 days."],"primaryCitation":"42 CFR §418.100(d)","citations":["22 CCR §74812(c)(16), (18), (19)","22 CCR §74816","22 CCR §74832(a)(7)","22 CCR §74844(a)(4)","22 CCR §74800(a)(19), (57)","22 CCR §74836(b)(3)(B)"],"federalCitations":["42 CFR §418.100(d)","42 CFR §418.24(b)(5), (d), (e)","42 CFR §418.26(e)","42 CFR §418.28(d)","42 CFR §418.308(c)-(d)","42 CFR §418.309","42 CFR §418.400","42 CFR §424.516(f)","42 U.S.C. §1320a-7k(d)"],"surveyorAsks":["Show me your current general liability and workers' compensation insurance certificates.","How do you make sure every Notice of Election is filed within 5 calendar days?"],"forms":[{"ref":"CA-HSP-FIN-01-A","title":"Notice of Election and Termination Filing Log"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.100(d))","5. Insurance, Funds and Fees","6. Patient Cost-Sharing and Charges","7. Notices to the Medicare Contractor (If Medicare-Certified)","8. The Aggregate Cap","9. Billing Integrity","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}