{"ref":"TX-FIN-02","title":"Billing and Insurance Claims","category":"Business","summary":"The Agency bills only for services that were actually provided, documented, and authorized, at the rates disclosed to the client or agreed with the payer, and it corrects and refunds any overpayment it discovers.","inShort":["We bill only for care that was actually given, as set out in the client’s service plan.","Clock in and out with EVV when required, and write down the real times and tasks at every visit.","Never record a visit before it happens, or for another caregiver, even if someone asks you to.","Tell the office if a visit was missed, cut short, or canceled, so the bill stays correct.","If anyone asks you to change a record, tell Pat Sample. You are never punished for honestly raising a billing concern."],"primaryCitation":"26 TAC §558.254","citations":["26 TAC §558.254","26 TAC §558.282","26 TAC §558.292","26 TAC §558.301","26 TAC §558.287","Tex. Hum. Res. Code ch. 36","Tex. Penal Code §35.02","Tex. Hum. Res. Code §36.115"],"federalCitations":["31 U.S.C. §3729","42 U.S.C. §1320a-7b","42 U.S.C. §1396b(l)","42 U.S.C. §1320a-7k(d)"],"surveyorAsks":["Pick a paid claim. Show me the visit record, the electronic visit verification data, and the authorization that support it.","How does a client learn what they will be charged before care starts?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (26 TAC §558.254)","5. Procedure","6. Responsibilities","6.1 Staff Training","7. Records","7.1 Compliance Monitoring","8. References","9. Related Documents","10. Approval","11. Revision History"],"version":"1.0","sample":false,"pack":"tx-pas","state":"Texas","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"agency":{"name":"Sample Home Care Agency","legalName":"Sample Home Care Agency, LLC","logo":null}}