Charges, Billing, Claims, and Overpayments
Makes sure the Agency bills only for services that were ordered, provided, documented, and signed as the rules require; tells patients about charges before care begins; and finds, reports, and returns overpayments on time.
About this policy
- Policy number
- GA-HH-BUS-02
- Version
- 1.0
- Main rule
- 42 CFR §409.43
- Library
- Georgia home health · 56 policies
- Category
- Business
- Sections
- 16
In short
- We only bill for visits that were ordered, actually made, and written up in a signed, dated note.
- Write your note the same day as the visit, and never change a note to match a bill.
- The plan of treatment and oral orders must be signed by the physician before Medicare is billed.
- Patients are told what they may owe before care starts.
- If you think we were paid for something we should not have been, tell the Administrator right away.
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 (42 CFR §409.43 and Ga. Comp. R. & Regs. 111-8-31-.09(b)-(c))
- 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
- Show me how you make sure the plan of treatment and any oral orders are signed before a claim is sent.
- How do you tell patients what Medicare, Medicaid, or their insurer will pay and what they will owe?
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