{"ref":"NC-HSP-FIN-01","title":"Billing Integrity, Notices to Medicare and NC Medicaid, and Care Regardless of Ability to Pay","category":"Business","summary":"Sets out the Medicare notice of election and notice of termination deadlines (5 calendar days), the NC Medicaid prior approval and election statement upload in NCTracks within six calendar days, prior approval for later benefit periods, reporting discharges and revocations to NC Medicaid, billing only what is documented, the inpatient and aggregate caps, and the rule that care is not reduced or stopped because a Medicare or Medicaid beneficiary cannot pay.","inShort":["Give billing the signed election statement and its effective date the same day it is signed.","Medicare notices of election and termination are due within 5 calendar days.","For NC Medicaid, the election statement and prior approval must be in NCTracks within six calendar days of the election.","Tell billing the same day about any discharge, revocation, transfer or death.","Never reduce or stop a patient's care because they cannot pay."],"primaryCitation":"42 CFR §418.24(e)","citations":["NC Medicaid Clinical Coverage Policy 3D, sections 5.1, 5.2.2, 5.6.1, 5.8, 5.12, 7.3.2.2","10A NCAC 13K .0303(a)","G.S. 131E-144.3(7)"],"federalCitations":["42 CFR §418.24(b)(5), (e)","42 CFR §418.26(e)","42 CFR §418.28(d)","42 CFR §418.30","42 CFR §418.100(d)","42 CFR §418.302","42 CFR §418.309","42 CFR §418.400"],"surveyorAsks":["How do you make sure the notice of election is filed within 5 calendar days?","For this NC Medicaid patient, when was the election statement uploaded in NCTracks?"],"forms":[{"ref":"NC-HSP-FIN-01-A","title":"Election, Notice and Prior Approval Filing Log"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.24(e))","5. Medicare Notices","5.1 Working days and weekends","6. NC Medicaid","7. Billing Integrity","8. Care Regardless of Ability to Pay","9. Responsibilities","10. Records and Compliance Monitoring","11. Staff Training","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"nc-hospice","state":"North Carolina","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}}