Insurance, Billing Integrity, Continuation of Care and Notices to Medicare
Covers the Agency's financial duties: the liability and workers' compensation insurance stated for licensure, paying licensing fees on time, never reducing care because a Medicare or Medi-Cal patient cannot pay, telling patients about cost-sharing, filing Notices of Election and termination within 5 calendar days, managing the Medicare aggregate cap, billing accurately and returning overpayments.
About this policy
- Policy number
- CA-HSP-FIN-01
- Version
- 1.0
- Main rule
- 42 CFR §418.100(d)
- Library
- California hospice · 60 policies
- Category
- Business
- Sections
- 17
In short
- The Agency never reduces or stops a patient's care because the patient cannot pay.
- The Notice of Election is filed with Medicare within 5 calendar days of the election.
- Notices of discharge or revocation are filed within 5 calendar days.
- Bill only for care that was given and documented, at the level of care the record supports.
- Tell the Administrator about any billing error so overpayments are returned within 60 days.
What's inside
17 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (42 CFR §418.100(d))
- 5. Insurance, Funds and Fees
- 6. Patient Cost-Sharing and Charges
- 7. Notices to the Medicare Contractor (If Medicare-Certified)
- 8. The Aggregate Cap
- 9. Billing Integrity
- 10. Responsibilities
- 11. Records and Compliance Monitoring
- 12. Staff Training
- 13. References
- 14. Related Policies and Forms
- 15. Approval
- 16. Revision History
An inspector may ask
- Show me your current general liability and workers' compensation insurance certificates.
- How do you make sure every Notice of Election is filed within 5 calendar days?
See Cura Core with your agency's name on it.
Choose your state and type of agency, buy your Policy Pack online and get your sign-in by email. Already a customer? Sign in to your portal.