{"ref":"PA-HSP-FIN-01","title":"Billing, Notices to Medicare and Medical Assistance, and Continuation of Care","category":"Business","summary":"Sets out how the Agency keeps its finances sound, files the Medicare notices of election and termination on time, sends the County Assistance Office the notices Pennsylvania Medical Assistance requires, bills accurately for each level of care, never cuts care because a patient cannot pay, and returns overpayments.","inShort":["Give the billing lead a signed election statement the same day it is signed. Medicare must be notified within 5 calendar days.","Tell the billing lead the same day a patient is discharged, revokes, transfers or dies.","For Medical Assistance patients, the County Assistance Office must be told in writing within 7 calendar days of election, revocation, a change of hospice or death.","Care is never cut because a Medicare or Medicaid patient cannot pay.","Bill only for care that was given and documented."],"primaryCitation":"42 CFR §418.24(e)","citations":["55 Pa. Code §1130.52(c)","55 Pa. Code §1130.71","55 Pa. Code §1130.72","55 Pa. Code §1130.73","55 Pa. Code §1101.51(e)","55 Pa. Code §1130.22(5)"],"federalCitations":["42 CFR §418.24(e)","42 CFR §418.26(e)","42 CFR §418.28(d)","42 CFR §418.100(d)","42 CFR §418.301","42 CFR §418.302","42 CFR §418.309","42 CFR §418.3","42 CFR §424.516(f)","42 CFR §401.305"],"surveyorAsks":["How do you make sure the Notice of Election is filed within 5 calendar days?","When a Medical Assistance recipient elects hospice, revokes, changes hospice or dies, who tells the County Assistance Office, and when?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.24(e))","5. Budget and Solvency","6. Medicare Notices and Claims","6.1 Notice of Election","6.2 Notice of termination/revocation","6.3 Pre-billing checks","6.4 Payment rules and limits","7. Medical Assistance Notices and Claims","8. Telling Patients What They May Owe","9. Corrections, Overpayments and Records","10. Responsibilities","11. Records and Compliance Monitoring","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"pa-hospice","state":"Pennsylvania","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}}