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Charges, Billing, Claims, and Overpayments

Sets out how the Agency tells patients about charges, what must be in place before a Medicare or Michigan Medicaid claim is submitted (signed plan of care, countersigned verbal orders, prior authorization number for Medicaid aide services, EVV), the Michigan Medicaid rules on billing beneficiaries, payment in full, timely filing and factoring, and how overpayments are reported and returned.

Preview: full text with a package
About this policy
Policy number
MI-HH-BUS-02
Version
1.0
Main rule
Michigan Medicaid Provider Manual, General Information for Providers, Sections 10, 11 and 13
Library
Michigan home health · 57 policies
Category
Business
Sections
16

In short

  • We bill only for visits that happened, were ordered, and are documented.
  • The plan of care must be signed and verbal orders countersigned before we bill Medicare or Michigan Medicaid.
  • Never ask a Medicaid patient to pay for a covered service or to top up Medicaid’s payment.
  • Tell patients before care starts what they may have to pay.
  • If you think a bill is wrong, tell the Administrator. Overpayments are returned on time.

What's inside

16 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (42 CFR §409.43 and Michigan Medicaid Provider Manual, General Information for Providers, Sections 10, 11 and 13)
  • 5. Before a Claim Is Sent
  • 6. Michigan Medicaid Billing Rules
  • 7. Claim Review and Billing Agents
  • 8. Errors and 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

  • How do you make sure the plan of care is signed and verbal orders are countersigned before you bill?
  • When can you bill a Michigan Medicaid patient directly?

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