Charges, Billing, Refunds, Claims, and Overpayments
Tells patients what each service costs and how they will be billed before care starts, bills every payer only for services that were authorized, delivered, and documented, never bills a Medicaid beneficiary for covered personal care, and returns any overpayment within 60 days of identifying it.
About this policy
- Policy number
- DC-HH-BUS-02
- Version
- 1.0
- Main rule
- 22-B DCMR §3908.1
- Library
- Washington, DC home health · 58 policies
- Category
- Business
- Sections
- 17
In short
- Patients are told before care starts what each service costs and who will pay.
- We bill only for visits that were authorized, actually happened, and are documented. Write your notes on the day of the visit.
- Never ask a DC Medicaid patient or family to pay for personal care aide services.
- If you think a bill or a timesheet is wrong, tell the billing lead or the Director right away.
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 (22-B DCMR §3908.1 and §3912.2(c))
- 5. Price List and Disclosure
- 6. Verifying Coverage and Authorization
- 7. Accurate Claims
- 8. Billing Patients and Families
- 9. Refunds, Credit Balances, and Overpayments
- 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
- Show me where this patient was told the charge for each service and the billing procedure.
- Show me the documentation that supports this claim, unit by unit.
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