Charges, Billing, Claims, Medi-Cal Records, and Overpayments
Bills only for services that were ordered, provided by qualified staff, documented on time, and covered; tells patients what they may have to pay before care starts and of any change within the time California and federal rules allow; keeps Medi-Cal service records for 10 years; and returns overpayments, including Medicare overpayments within the federal 60-day rule.
About this policy
- Policy number
- CA-HH-BUS-02
- Version
- 1.0
- Main rule
- Cal. Welf. & Inst. Code §14124.1
- Library
- California home health · 58 policies
- Category
- Business
- Sections
- 16
In short
- We bill only for visits that were ordered, actually made, and written up.
- Write your visit note at the time of the visit. Notes must be signed and in the record within seven working days.
- Patients are told before care starts what they may have to pay, and told about any change.
- Never change a note to make a claim pay. If you see a billing mistake, tell the Administrator.
- Money paid to us by mistake is paid back.
What's inside
16 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (Cal. Welf. & Inst. Code §14124.1)
- 5. Telling Patients About Charges
- 6. Conditions Before a Claim Is Sent
- 7. Claim Review
- 8. Overpayments
- 9. Responsibilities
- 10. Records and Compliance Monitoring
- 11. Staff Training
- 12. References
- 13. Related Policies and Forms
- 14. Approval
- 15. Revision History
An inspector may ask
- Walk me through what billing checks before a claim goes out.
- How do you make sure a visit was made by a qualified person who was not excluded or suspended?
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