{"ref":"DC-HSP-FIN-01","title":"Billing, Notices to Medicare and DC Medicaid, Prior Authorization and Continuation of Care","category":"Business","summary":"Sets the billing steps that protect patients and the Agency: the Notice of Election within 5 calendar days, notices of termination or revocation within 5 calendar days, no claim before written certification, the inpatient day and aggregate cap limits, quality reporting, what patients may owe, DC Medicaid prior authorization for each election period and the other DC Medicaid payment rules, care regardless of ability to pay, and correction of errors.","inShort":["Give the signed election statement to billing the same day it is signed.","The Notice of Election must reach Medicare within 5 calendar days, or those days cannot be paid.","No claim is sent until the written certification is in the record.","For DC Medicaid patients, prior authorization is needed for each election period.","We never reduce or stop care because a patient cannot pay."],"primaryCitation":"42 CFR §418.24(e)","citations":["29 DCMR §939.25","29 DCMR §939.26","29 DCMR §939.27","29 DCMR §939.29","29 DCMR §939.30","29 DCMR §939.31","29 DCMR §939.20(i)(4)","D.C. Code §44-405(a)","D.C. Code §44-401(20)"],"federalCitations":["42 CFR §418.24(b)(5), (e)","42 CFR §418.26(e)","42 CFR §418.28(d)","42 CFR §418.22(a)(2), (a)(4)(ii)","42 CFR §418.100(d)","42 CFR §418.108(d)","42 CFR §418.204(b)","42 CFR §418.302","42 CFR §418.306(b)","42 CFR §418.309","42 CFR §418.400","42 CFR §424.507(b)","42 CFR §424.516(f)","42 CFR §401.305"],"surveyorAsks":["Show me the Notice of Election dates for your last ten admissions. Were any late?","How do you make sure no claim is sent before the written certification is in the record?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.24(e))","5. Before Any Claim Is Sent","6. Medicare Notices","6.1 Notice of Election","6.2 Notice of termination or revocation","7. Payment Rules and Limits","8. DC Medicaid (If the Agency Is Enrolled)","9. Telling Patients What They May Owe","10. Care Regardless of Ability to Pay","11. Corrections, Overpayments and Records","12. Responsibilities","13. Records and Compliance Monitoring","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"dc-hospice","state":"Washington, DC","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}}