Quality Assurance prior to Billing

Introduction

Date of Last Review 4/8/08
SME: Director of Financial Operations

Policy
The Harris County Psychiatric Center (HCPC) requires 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.

Procedure

HCPC Staff:

1. Patient Accounting staff will verify charge capture information from clinical system to the patient accounting system daily.

Outsource Provider*:

2. 100% of all accounts edited out of the claim scrubber are reviewed for appropriate handling prior to submission.
3. All coding changes, adds or deletions are provided by the client. No staff member is allowed to make coding changes without written authorization from the client.

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Related standards

The Joint Commission : Leadership

JCAHO MA 4
UTHSC-H Handbook of Operating Procedures

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