10 Colo. Code Regs. § 2505-10-8.045.1
Current through Register Vol. 47, No. 20, October 25, 2024
Section 10 CCR 2505-10-8.045.1 - PROHIBITION AGAINST PROVIDER REASSIGNMENT OF CLAIMS TO BENEFITSFor purposes of this section, the following definitions shall apply:
a. "Organized Health Care Delivery System" is a public or private organization for delivering health services. The system may include, but is not limited to, a clinic or a group practice prepaid capitation plan.b. "Factor" is an organization; i.e., collection agency or service bureau, which, or an individual who, advances money to a provider for his accounts receivable which the provider has assigned or sold, or otherwise transferred, including transfer through the use of a power of attorney, to this organization or individual. The organization or individual receives an added fee or a deduction of a portion of the face value of the accounts receivable in return for the advanced money. For purposes of this regulation, the term "factor" does not include business representatives, such as billing agents or accounting firms as described within this section..11 No payment under the State Medical Assistance program for any care or services furnished to an eligible individual by a health care provider shall be made to anyone other than that provider, except as specified in this section..12 Payments may be made to other than the provider of service when:a. That payment is made in accordance with an assignment from the provider to a government agency or an assignment made pursuant to a court order;b. That payment is made to a business agent (such as a billing service or accounting firm) who renders statements and receives payments in the name of the provider, if the agent's compensation for this service is:(1) Reasonably related to the cost of processing the billings,(2) Not related on a percentage or other basis to the dollar amounts to be billed or collected, and(3) Not dependent upon the actual collection of payment. With respect to physicians, dentists or other individual practitioners, payment may be made:
a. To the employer of the physician, dentist, or other practitioner if the practitioner is required as a condition of his employment to turn over his fees to his employer; orb. To a foundation, plan, or similar organization, including a health maintenance organization, which furnishes health care through an organized health care delivery system if there is a contractual arrangement between the organization and the person furnishing the service under which the organization bills or receives payments for such person's services..14 Payment under the Medical Assistance program for any care or service furnished to an eligible individual by a provider shall not be made to or through a factor, either directly, or by virtue of a power of attorney given by the provider to the factor.