Charges, Billing, Claims, and Overpayments
Sets out how the Agency tells patients what will be paid and what they may owe, meets the MO HealthNet home health payment conditions in 13 CSR 70-90.010 (orders with a face-to-face encounter, a plan of care reviewed at least every 60 days, visit limits) and the Medicare conditions where it is certified, reviews every claim before billing, accepts MO HealthNet payment as payment in full, and reports and returns overpayments on time.
About this policy
- Policy number
- MO-HH-BUS-02
- Version
- 1.0
- Main rule
- 13 CSR 70-90.010
- Library
- Missouri home health · 57 policies
- Category
- Business
- Sections
- 18
In short
- Before care starts, patients are told what Medicare or MO HealthNet will pay and what they may owe.
- We bill only for visits that were ordered, made and documented.
- MO HealthNet patients are never charged for covered services.
- Write your visit note at the time of the visit; it supports the claim.
- If you think a visit was billed in error, tell the Administrator right away.
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 (13 CSR 70-90.010)
- 5. Telling Patients About Payment
- 6. MO HealthNet Home Health Conditions
- 7. Medicare Conditions (If Medicare-Certified)
- 8. Pre-Billing Review
- 9. Patient Charges
- 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 tell patients, before care starts, what Medicare or MO HealthNet will pay and what they may have to pay?
- Show me how you check a claim before it is billed: orders, plan of care, visit notes, EVV match.
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