Charges, Billing, Claims, and Overpayments
Sets out how the Agency tells patients about payment sources and charges, bills only for services that were ordered, provided and documented, meets Medicare conditions for payment if certified, follows Louisiana Medicaid and other payer rules, reviews claims before they are sent, and reports and returns overpayments, in line with the Louisiana Medical Assistance Programs Integrity Law and federal rules.
About this policy
- Policy number
- LA-HH-BUS-02
- Version
- 1.0
- Main rule
- R.S. 46:438.3
- Library
- Louisiana home health · 57 policies
- Category
- Business
- Sections
- 18
In short
- We bill only for visits that were ordered, made and documented.
- Write each clinical note yourself, with your arrival and departure times, and turn it in within one week.
- Patients are told before care starts what Medicare, Medicaid or insurance may pay and what they may owe.
- Never write a note for a visit you did not make.
- If you think a bill is wrong, tell the Administrator. We return any overpayment.
What's inside
18 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (R.S. 46:438.3)
- 5. Documentation Required Before Billing
- 6. Medicare Conditions (If Medicare-Certified)
- 7. Louisiana Medicaid and Other Payers
- 8. Pre-Billing Review
- 9. Patient Accounts
- 10. Errors and Overpayments
- 11. Responsibilities
- 12. Records and Compliance Monitoring
- 13. Staff Training
- 14. References
- 15. Related Policies and Forms
- 16. Approval
- 17. Revision History
An inspector may ask
- How do you make sure you bill only for visits that were made and documented?
- How do you tell patients what they may have to pay before care begins?
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