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. |
| 1.2 | For the purposes of this policy, inpatient services at Harris County Psychiatric Center shall be defined as the facility component of treatment rendered to patients that have been admitted with the intent of remaining in the facility for a time period greater than 23 hrs. |
| The professional component of these inpatient services shall be addressed in a separate policy and procedure. | |
| 1.3 | Harris County Psychiatric Center (HCPC) shall bill all inpatient services rendered in a timely and efficient manner. All inpatient services shall be billed at discharge in accordance with established procedures for record and claim completion and established suspense time. If applicable and allowable, patients staying longer than 30 days shall be billed on an interim basis. |
| 1.4 | Charges 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 | All HCPC staff members are responsible for ensuring that services rendered and treatment performed has been ordered by a physician and is medically necessary. However the primary responsibility for these determinations shall lie with the active treatment professionals. Reimbursement staff will monitor final billed charges within the context of proper billing and may perform periodic audits to determine if appropriate guidelines have been followed. |
| 1.6 | The diagnoses submitted with the claim must be the diagnoses that was supplied by the patient’s treatment professional and should accurately reflect the patient’s illness, disorder, disease and/or behavior. The assignment of diagnoses has been and will continue to be the responsibility of the patient's attending physician. The HIM Department has primary responsibility for ensuring that any diagnoses entered in the system which are subsequently used for billing, are those assigned by the patient's treatment professional. Patient Account Services staff have the responsibility for questioning any diagnoses codes that appear on a claim that may be inaccurate, i.e. a diagnosis of a pregnancy for a male patient. |
| 1.7 | 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. |
| 1.8 | Any staff member who reviews an account and finds a charge, diagnosis and/or codes that appears to be inappropriate has the OBLIGATION to verify the item with the originating department. Corrections should be made by the staff member or Area Coordinator in accordance with established procedures. |
| 1.9 | 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. |
| 1.10 | Unless otherwise instructed by the third party payer, all bills should be submitted with gross charges. |
| 1.11 | 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 his or her own activities within the system and file. The Area Coordinator is responsible for ensuring that documentation has been completed.
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Related standards
The Joint Commission : Leadership
JCAHO MA 4
UTHSC-H Handbook of Operating Procedures
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