Charges, Billing, Claims, and Overpayments
Sets the rules for charges and claims: bill only for services actually provided, documented and ordered; complete documentation and resolve electronic visit verification exceptions before billing Ohio Medicaid; accept Medicaid payment as payment in full; tell patients about charges before care starts; and report and return overpayments within the federal deadline.
About this policy
- Policy number
- OH-HH-BUS-02
- Version
- 1.0
- Main rule
- 42 CFR §401.305
- Library
- Ohio home health · 59 policies
- Category
- Business
- Sections
- 17
In short
- We bill only for visits that happened, were ordered, and are fully documented.
- Ohio Medicaid visits are billed only after EVV shows the visit and every exception is fixed.
- Medicaid patients are never billed for covered services.
- If you think a bill or a note is wrong, tell the Administrator right away. Money we were not owed is paid back.
- Never change a note or a visit time to make a claim pass.
What's inside
17 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 §401.305)
- 5. Before Any Claim Is Submitted
- 6. Charges and Notice to Patients
- 7. Corrections and Overpayments
- 8. Records and Audits
- 9. What the Law Forbids
- 10. Responsibilities
- 11. Records and Compliance Monitoring
- 12. Staff Training
- 13. References
- 14. Related Policies and Forms
- 15. Approval
- 16. Revision History
An inspector may ask
- Walk me through how a visit becomes a claim. What must be in the record before you bill?
- How do you make sure Ohio Medicaid claims are supported by EVV data?
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