Policy Manual sample

MDT Home Health Care Agency, Inc. REFUNDS EXTENSION OF CREDIT This Agency had agreed by participating as a Medicare certified home health agency not to charge any individual or other person such as a relative, or other insurance carriers for items covered by the health insurance program other than allowable charges and deductibles and co-insurance amounts. If moneys are incorrectly collected as follows, such moneys will be refunded: 1. Amounts collected in excess of allowable charges and deductible and co-insurance for covered items and services for which the individual is entitled to have payment made under the health insurance program. 2. Amounts incorrectly collected from a beneficiary or other person representing the beneficiary, such as a relative, or insurance carrier such as: N. Simple accounting errors O. Retroactive entitlement--beneficiary paid services and later became eligible for payment under Medicare P. Denied coverage--later found to be payable Q. Protests of a direct charge by an agency that the intermediary later finds that the beneficiary is entitled to coverage. Refunds will be made to the beneficiary or any other person from whom the agency collected moneys as promptly as possible or within 60 days, if possible, and will be made in accordance with applicable state law. The refund transaction will be noted in writing to the beneficiary and to the intermediary. If the beneficiary or other persons cannot be located after reasonable effort, the intermediary will be asked to check the Social Security Administration’s record in an effort to locate the responsible party. If the individual to whom refund is to be made still cannot be located or has died, the agency will make final disposition of moneys in accordance with state law. Home Health Agency Overall Plan and Budget F-20