Charges, Billing, Claims, and Overpayments
Gives every patient a written statement of services and the charges the patient must pay before care starts, bills only for services that were ordered, provided and documented, and reports and returns any overpayment on time: for Medicare, within 60 days after it is identified unless a timely, good-faith investigation suspends the deadline.
About this policy
- Policy number
- NC-HH-BUS-02
- Version
- 1.0
- Main rule
- G.S. 131E-144.3
- Library
- North Carolina home health · 57 policies
- Category
- Business
- Sections
- 16
In short
- Patients get a written statement of our services and what they will pay before care starts.
- We bill only for visits that were ordered, actually made, and documented.
- Never write a note for a visit that did not happen, and never change a time or date to match a bill.
- If you think we were paid for something we should not have been, tell the agency director 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 (G.S. 131E-144.3(7); 42 CFR §484.50(c)(7); 42 CFR §401.305)
- 5. Telling Patients About Charges
- 6. Before a Claim Is Submitted
- 7. Reviews and Audits
- 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 this patient was told, in writing, what Medicare or Medicaid would pay and what the patient would owe.
- How do you make sure a visit is documented and the plan of care is signed before you bill?
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