{"ref":"OH-HSP-FIN-01","title":"Billing, Care Regardless of Ability to Pay and Ohio Medicaid Hospice Reporting","category":"Business","summary":"Sets out how the Agency charges and bills for hospice care: care is never discontinued or reduced because a patient cannot pay; charges are disclosed; Medicare notices of election and termination are filed within five calendar days; Ohio Medicaid hospice enrollment data are entered in the ODM provider web portal before any claim; and claims, room and board, coinsurance, the cap and quality reporting are handled correctly.","inShort":["Care is never stopped or reduced because a patient cannot pay.","Patients are told about services, limits and any charges before or at admission.","Tell billing the same day about any admission, change in level of care, transfer, discharge, revocation or death.","Medicare notices of election and of discharge or revocation must be filed within 5 calendar days.","For Ohio Medicaid patients, the hospice enrollment must be entered in the ODM portal before any claim is sent."],"primaryCitation":"ORC 3712.06(F)","citations":["ORC 3712.06(F)","OAC 3701-19-07(A)(6)","OAC 3701-19-12(G)","OAC 3701-19-20(E)","OAC 5160-56-02(B)-(E), (H)","OAC 5160-56-03(A)(2)","OAC 5160-56-03.3","OAC 5160-56-04(D)","OAC 5160-56-05(E)","OAC 5160-56-06","OAC 5160-1-17.2(A)-(F)"],"federalCitations":["42 CFR §418.100(d)","42 CFR §418.24(e)","42 CFR §418.26(e)","42 CFR §418.28(d)","42 CFR §418.302","42 CFR §418.309","42 CFR §418.312","42 CFR §418.400"],"surveyorAsks":["Has the Agency ever discontinued or reduced a patient's care because of inability to pay?","Show me the notice of election for this Medicare patient and the date it was filed."],"forms":[{"ref":"OH-HSP-FIN-01-A","title":"Ohio Medicaid Hospice Enrollment Entry Checklist"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (ORC 3712.06(F); 42 CFR §418.100(d))","5. Charges and Financial Counseling","6. Medicare Notices and Claims","7. Ohio Medicaid: Enrollment Reporting Before Claims","8. Ohio Medicaid Claims and Payment","9. Coinsurance","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-hospice","state":"Ohio","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}}