Introduction
Date of Last Review 4/8/08
SME: Director of Financial Operations
| 1.1 | HCPC shall maintain sound non-discriminatory billing and collection practices that will enhance cash flow and reduce bad debt. Reimbursement activities shall commence prior to or upon admission and continue until the account is paid or is referred to an outside Collection Agency. Reimbursement policies and procedures shall be uniformly applied to all patients. |
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| 1.2 | For the purposes of this policy, outpatient services at Harris County Psychiatric Center shall be defined as the facility component of treatment rendered to patients that: |
| a. Are in the partial hospitalization program, b. Are in the intensive outpatient program, c. Are admitted for short term observation with an expected stay of under 24 hours, d. Have evaluations and assessments rendered without subsequent treatment at HCPC e. Have tests and services ordered and performed in conjunction with these treatments. f. AND are NOT inpatients of HCPC at the time the service or treatment is performed |
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(Medicare inpatients who have exhausted their benefits and are being billed in accordance with HIM-10 instructions for ancillary billing are detailed in a subsequent policy and procedure.). The professional component of these outpatient services shall be addressed in a separate policy and procedure. |
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| 1.3 | Harris County Psychiatric Center (HCPC) shall bill all outpatient services rendered in a timely and efficient manner. All outpatient services must be billed at least monthly and/or at discharge. |
| 1.4 | Charged should correctly reflect services that have been ordered by an authorized professional, documented within the patient record and are medically necessary for the patient’s treatment. Charge integrity shall be monitored and periodically audited to ensure that the correct charge for service rendered has been correctly posted to a patient account. This monitoring and audit shall be the responsibility of the PAS billing staff and may be periodically completed by UT audit staff or other outside parties. The use of other parties for this review DOES NOT relieve the PAS staff from completing these functions |
| 1.5 | The diagnoses submitted with the claim must be the diagnoses supplied by the patient’s treatment professional and should accurately reflect the patient’s illness, disorder, disease and/or behavior. The assignment of diagnoses have been and will continue to be the responsibility of the patient's attending physician. |
| 1.6 | HCPCS or CPT codes and modifiers used should accurately reflect the service or treatment performed. Such codes should be initially supplied, modified and periodically reviewed by a party trained and/or experienced in the use of the coding system |
| 1.7 | Any staff member who reviews an account and finds a charge, diagnosis and/or code that appears to be inappropriate has the obligation to verify the item with the originating department. Corrections should be made in accordance with established procedures |
| 1.8 | All bills submitted must be neat, accurate and complete. A complete claim shall be defined, as a “clean” claim that contains all information needed by the payer. The exact data that is needed by each payer will be contained within the appropriate third party provider manual, the Medicare HIM 10 manual or within the procedures that follow. |
| 1.9 | Unless otherwise instructed by the third party payer,all bills should be submitted with gross charges. |
| 2.0 | Any outpatient service performed within one (1) day of inpatient admission can not be separately billed to Medicare. Medicare considers these services to be part of the Inpatient claim and any such charges should be transferred to the Inpatient account. Note that the regulation states three days for PPS facilities and one day for Non-PPS hospitals and Exempt Units. The regulation also states that the services need to be considered related to the Inpatient admission. Due to the nature of the services and treatment rendered at HCPC, specifically mental and behavioral health, it shall be assumed that all services performed within the one-day window are related to the subsequent Inpatient admission. |
| 2.1 | ALL ACTIVITY MUST BE DOCUMENTED. This includes notes detailing the verification of a diagnosis, charge or code that was found to be correct. Documentation should consist of understandable notes made in the SMS system and/or in the patient account file. The staff member who performs the function is responsible for documenting their own activities within the system and file.
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Related standards
The Joint Commission: Ethics, Rights, and Responsibilities
The Joint Commission : Leadership
Center for Medicare and Medicaid Services
UTHSC-H Handbook of Operating Procedures
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