Billing, Claims, and Medicare Payment Conditions
Requires every bill and claim to be accurate and supported by the record, and, for Medicare, sets out the checks the billing office makes before a claim goes out: certification, face-to-face encounter, signed plan of care, countersigned verbal orders, and OASIS. It also explains how charges are disclosed and how overpayments are returned.
About this policy
- Policy number
- TX-HH-BUS-02
- Version
- 1.0
- Main rule
- 26 TAC §558.254
- Library
- Texas home health · 56 policies
- Category
- Business
- Sections
- 15
In short
- We bill only for visits that were ordered, made, and documented.
- Write your visit note on the day of the visit. Never chart a visit before it happens.
- Get verbal orders signed by the doctor or practitioner quickly. Medicare will not pay until they are signed.
- Tell patients before care starts what they may have to pay.
- If you think a bill or claim is wrong, tell the Administrator. You will not be punished for reporting.
What's inside
15 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (26 TAC §558.254)
- 5. Medicare Pre-Billing Checks
- 6. Procedure for All Payers
- 7. Private-Pay Patients
- 8. Responsibilities
- 9. Records and Compliance Monitoring
- 10. Staff Training
- 11. References
- 12. Related Policies and Forms
- 13. Approval
- 14. Revision History
An inspector may ask
- How do you make sure you bill only for visits that were made and documented?
- Show me how you check that the plan of care and any verbal orders were signed before this Medicare claim was submitted.
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