Wiki Written Legal Billing Guidelines

[rhedges]

I am looking for written legal guidelines for billing issues. So much info has been passed down verbally but there is nothing in writing to support it. An example is "you can't treat one financial class differently than another". This would be an example of writing off a balance due on a cash patient but not being able to write off a small balance on a Medicare patient. Or if a BCBS patient exhaust benefits you offer them a different fee schedule than a cash patient.

Does anyone have OIG approved guidelines that govern approved billing practices?

 

[nvandepol@nefhs.org]

I do not, but would very much be interested in seeing the same in black and white.

 

[mitchellde]

There are numerous "laws" regarding these types of billing practices. Some are covered in HIPAA, some are federal laws, some are OIG compliance regulations. There are so many. You should start with a Google search if nothing else, that is how I started, one will give you a reference that will,take you to another and so on. Sometimes it is one that you don't even think would apply like discrimination, or most favored nations. But they do apply and you can see it once it is pointed out. False claims act, also comes into play, and in some places specific State laws will apply. You will not get it all in a day, it took me weeks to track down everything I needed to get this information to "prove" to the clinics I work with that this is all bad practice and can be illegal. Just start searching, it is very enlightening!

 

[AlaskanCoder]

I've been googling for hours and cannot find what I need. Perhaps you have a suggestion. I have a clinic who occasionally does a lab draw on a Medicare patient and wants the billing company to bill Medicare. They have been told multiple times that the clinical lab has to bill Medicare, but the clinic has the patient sign an ABN and they say that we can just bill the secondary or the patient when Medicare denies. Even when we show them the EOMB with the "CO" denial, they don't comply. I'm looking for something official that says it is against the law to bill the patient when they are not complying with Medicare billing regulations. BTW, they are participating with Medicare.
Thank you!

 

[mitchellde]

What you need should be in the medicare manual. Look under words like patient responsibility when provider is participating in medicare. I do long sentence searches. I use phrases like physician professional courtesy discounts. Or allowable patient charges for medicare. Right now you want to know when it is appropriate to obtain an ABN for billable lab charges so try that whole phrase. I know it takes a long time but I do not have any direct links to give you. I just search and search within a search.