{"ref":"OH-HH-BUS-02","title":"Charges, Billing, Claims, and Overpayments","category":"Business","summary":"Sets the rules for charges and claims: bill only for services actually provided, documented and ordered; complete documentation and resolve electronic visit verification exceptions before billing Ohio Medicaid; accept Medicaid payment as payment in full; tell patients about charges before care starts; and report and return overpayments within the federal deadline.","inShort":["We bill only for visits that happened, were ordered, and are fully documented.","Ohio Medicaid visits are billed only after EVV shows the visit and every exception is fixed.","Medicaid patients are never billed for covered services.","If you think a bill or a note is wrong, tell the Administrator right away. Money we were not owed is paid back.","Never change a note or a visit time to make a claim pass."],"primaryCitation":"42 CFR §401.305","citations":["OAC 5160-1-17.2(A)","OAC 5160-1-17.2(B)","OAC 5160-1-17.2(C)","OAC 5160-1-17.2(D)","OAC 5160-1-17.2(E)","OAC 5160-12-03(B)(9)","OAC 5160-12-04","OAC 5160-32-02(H)","ORC 2913.40","ORC 5164.35"],"federalCitations":["42 CFR §401.305","42 U.S.C. §1320a-7k(d)","42 CFR §484.50(c)(7)","42 CFR §409.43"],"surveyorAsks":["Walk me through how a visit becomes a claim. What must be in the record before you bill?","How do you make sure Ohio Medicaid claims are supported by EVV data?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §401.305)","5. Before Any Claim Is Submitted","6. Charges and Notice to Patients","7. Corrections and Overpayments","8. Records and Audits","9. What the Law Forbids","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":"oh-hha","state":"Ohio","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}