BILLING FLOW CHART - DOC - DOC by ntt14317

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									                                      (Program Title)

       SCHOOL BASED HEALTH CENTERS POLICIES AND PROCEDURES

                                           Billing


POLICY STATEMENT

Parents/guardians, students, staff, and partner agencies will understand the health
center’s billing policy. Health center billing procedures will be in compliance with
requirements of state and federal government and contracting third party payers.


PROCEDURE

The School Based Health Center (SBHC) will maintain eligibility for billing
Medicaid/KIDMED. The SBHC Medicaid provider number is______________________.

Confidentiality of students will be protected in accordance with HIPAA guidelines.
Confidentiality policy supersedes any billing concerns.

The health center will refer all uninsured students to the SBHC mental health provider
for assistance with submitting a LaCHIP application.

The SBHC will bill uniformly for all services. The parent/guardian or patient is not
responsible for any out-of-pocket co-payments, deductibles and/or non-covered
services. All net collections for services delivered by providers who are supported by
the SBHC will accrue to the SBHC.

SBHC procedure will promote accurate billing and reimbursement without impeding
assess to health center services or incurring unexpected expense for parents or
students.

No enrolled student will be denied access to on-site health center services because of
inability to pay.

Bill for off-site referral services to SBHC-enrolled patients will be the responsibility of
the agency or individual providing that service. The SBHC will obtain any needed
Primary Care Physician (PCP) referral before referring a Medicaid/LaCHIP patient for
off-site services.

Patient and partner agencies will address all billing concerns to the SBHC Director for
consideration.

The SBHC will implement a billing compliance process.
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At the time of enrollment in the SBHC, the enroller will request the following
information from the person enrolling the student (emancipated student or
parent/guardian of student):

      Insurance care (or, if unavailable, the name of primary insured, insurance
       company, identification and group numbers). At least two attempts will be
       made requesting the patient’s insurance card. These attempts will be
       documented in the chart.

      Consent for SBHC services, including authorization for billing and agreement to
       notify SBHC if insurance changes.

      If the student is not covered by insurance, the student will be referred to the
       SBHC mental health provider for assistance with submitting a LaCHIP
       application.

      Staff will update insurance data at the time of each contact with the
       emancipated student or parent/guardian of student, prior to an off-site referral,
       and at least annually or as directed by the SBHC Director.

      The SBHC will bill uniformly.

Staff will document in the medical record all contacts with students,
parents/guardians, and insurance carriers about billing issues.

Rejected claims will be referred to the SBHC Director or Office Manager by the billing
agent for follow-up. Any missing information will be provided to the billing agent and
the claim will be refiled. Any incorrectly coded information will have the correct code
applied with the SBHC Director and Nurse Practitioner’s approval of the corrected code
and the claim will be refiled.

The billing agent will provide a log of all denied claims to the SBHC. They will also
provide a monthly report of all reimbursements by provider and payer. These items
will be maintained in the SBHC by the SBHC Director.

Parents or students with billing concerns, which cannot be satisfied by discussion with
the clerical staff, will be referred to the SBHC Director. The SBHC Director will consult
with the SBHC billing consultant as needed. The SBHC Director will involve the SBHC
or sponsoring agency attorney if the concern remains unresolved to the satisfaction of
both parties.

The staff will refer all third-party payers or government officials with billing concerns
to the SBHC Director. The SBHC Director will involve the legal representation if the
concern remains unresolved to the satisfaction of both parties.


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The SBHC Director will maintain records of all billing concerns referred to the SBHC
Director.

Definitions:

    1. Contracting third-party payers – public and private insurers, including
       Medicaid, LaCHIP, and private insurance carriers who credential SBHC
       providers.

    2. Uninsured students – students who have no health insurance and students
       whose health or accident insurance does not cover core services of the SBHC or
       services which the SBHC staff determines are needed by the student.

    3. Waiver collection – to completely or partially waiver co-payments,
       deductibles and/or fees for non-covered services based on financial need as
       determined by family size and income.

    4. Partner agencies – agencies participating in provision of services to SBHC
       patients.



Approval: ____________________________
                       SBHC Director



Date: _______________________________




Revised January 2007
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                                                                                 BILLING FLOW CHART


                                             Student enter clinic. The following are verified to be in chart
                                                 1. Consent form signed & witnessed by SBHC staff
                                                 2. Copy of insurance card or 2 letters requesting copy
                                                 3. Yellow Health History Update
                                                 4. Growth Chart
                                                 5. HIPAA Form




                                                               SBHC Encounter Form entered into
                                                                       Clinical Fusion




                                                                     Run Clinical Fusion Billing
                                                                              Reports




                                                                    Does patient have medical
                                     Yes                                   coverage                                   No




Medicaid Under 10     Medicaid Over 10              Private Insurance                                          Refer to Social Worker for LaCHIP
Request referral      Request referral              Copy Ins. Card or ins. billing                                        application
from PCP              from PCP for lab,             information & attach to
                      x-ray, etc. only              transmission form




 No referral –
 hold bill until    Referral received – fax                 Fax bill & ins.
 received           bill & referral to billing              Info/card to
                    company                                 billing company


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