Scenarios › Bill It Right › Episode 1
Bill It Right · Episode 1 · Free
Not in the Plan
Kevin bills a service the person's plan doesn't include.
In this scene
Kevin: Mr. Davis had extra companion hours this week. I billed them like his other services.
Priya: Companion care isn't in his service plan. Without an authorization, we can't bill it.
Kevin: But our staff really worked those hours.
Priya: Then we tell his case manager. If he needs the service, the plan gets updated first. Billing comes after.
Kevin: So I pull the claim and email the case manager.
Questions to think about
- A service isn't in the person's plan. You:
- Who updates the person's plan?
- Staff worked hours outside the plan. Those hours:
Bill only what's authorizedOnly bill services that are in the person's approved plan, within the authorized amount. If someone needs a service that isn't authorized, tell the case manager so the plan can be updated first. Work outside the plan can't simply be billed.
About this series
For billing staff and agency owners: authorizations, real units, documentation, hospital stays, upcoding, overlaps, duplicates, denials, overpayments and self-audits.