Policy Manual sample

MDT Home Health Care Agency, Inc. PROCEDURE TO ENSURE ACCURATE BILLING AND INSURANCE CLAIMS, THIRD PARTY PAYERS 1. Prior to the initiation of services the admitting nurse verifies patient insurance coverage with the patient. 2. The extent to which the patient’s insurance covers the services ordered by the patient’s physician is discussed with the patient. The patient signs a service agreement documenting the extent services are covered by insurance and the amount of payment required by the patient. 3. A Daily Activity Record (DAR) is maintained by all visit staff documenting date, time, and type of visit made. The DAR is submitted with visit notes for that day’s visits attached. 4. The visit notes are compared to the DAR for accuracy. Then the DAR is sent to data entry. 5. Data entry logs the visits into the computer and files the DAR. 6. The billing week is Sunday through Saturday. 7. A computer calendar is generated weekly showing visits logged during the specific billing period and the actual patient visit calendars are submitted which have been reconciled with the patient charts for the same billing period. The billing clerk compares the computer calendar to the visit calendar. The computer calendar is then reconciled to match the visit calendar. 8. All visits that require deleting from the computer are verified with the DAR. Should the DAR indicate the visit was made, yet it does not appear on the patient calendar, the discrepancy is referred back to the branch billing clerk to verify. The bill is held until verification can occur. 9. A second computer calendar is generated and verified for data entry errors. 10. Once the above process verifies the information is accurate a bill is generated. 11. A computer check is now performed and any technical billing errors are corrected. 12. A prebill worksheet is generated for all claims pertaining to the billing period. All claims held are highlighted. 13. Complete and accurate claims are generated and an electronic UB92 is sent to Medicare or other payment source. 14. An electronic generated report is printed. 15. The bills are then dropped into the ledger where they await payment. A bill batch report is generated. 16. Generated reports are maintained in binders by the billing department. 17. All claims that are held are reviewed on a weekly basis, reported to the appropriate branch and one the error is corrected the claim is released for payment. 18. No claims are submitted without signed physician plan of treatment and/or orders. Home Health Agency Overall Plan and Budget F-14