{"ref":"TX-HH-BUS-02","title":"Billing, Claims, and Medicare Payment Conditions","category":"Business","summary":"Requires every bill and claim to be accurate and supported by the record, and, for Medicare, sets out the checks the billing office makes before a claim goes out: certification, face-to-face encounter, signed plan of care, countersigned verbal orders, and OASIS. It also explains how charges are disclosed and how overpayments are returned.","inShort":["We bill only for visits that were ordered, made, and documented.","Write your visit note on the day of the visit. Never chart a visit before it happens.","Get verbal orders signed by the doctor or practitioner quickly. Medicare will not pay until they are signed.","Tell patients before care starts what they may have to pay.","If you think a bill or claim is wrong, tell the Administrator. You will not be punished for reporting."],"primaryCitation":"26 TAC §558.254","citations":["26 TAC §558.254","26 TAC §558.282","26 TAC §558.292","26 TAC §558.301","Tex. Hum. Res. Code ch. 36","Tex. Penal Code §35.02"],"federalCitations":["42 CFR §409.43","42 CFR §424.22","42 CFR §401.305","42 U.S.C. §1320a-7k(d)","31 U.S.C. §3729","42 CFR §484.50(c)(7)","42 CFR §484.50(c)(8)"],"surveyorAsks":["How do you make sure you bill only for visits that were made and documented?","Show me how you check that the plan of care and any verbal orders were signed before this Medicare claim was submitted."],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (26 TAC §558.254)","5. Medicare Pre-Billing Checks","6. Procedure for All Payers","7. Private-Pay Patients","8. Responsibilities","9. Records and Compliance Monitoring","10. Staff Training","11. References","12. Related Policies and Forms","13. Approval","14. Revision History"],"version":"1.0","sample":false,"pack":"tx-lhhs","state":"Texas","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 Home Health Agency","legalName":"Sample Home Health Agency, LLC","logo":null}}