Okla. Admin. Code § 130:12-9-1

Current through Vol. 42, No. 3, October 15, 2024

Section 130:12-9-1 - Billing

(a)Inpatients.

(1)General. The Center shall bill and attempt to collect the established full daily rate for all inpatient services unless the inpatient has been admitted to a charity care bed. Upon admission, the inpatient or legal guardian shall provide all information necessary to collect payment from third party payors if applicable.

(2)Medicaid. Medicaid shall be filed and accepted as payment in full for those Medicaid eligible inpatients except for Medicaid spend-downs that are the inpatient's responsibility.

(3)Third party payor(s). Claims shall be filed with third party payors in accordance with appropriate procedures. In cases where the third party payor does not cover the full amount of the bill, the inpatient shall be responsible for the remaining amount. In cases where an inpatient requests services that are not covered or for which authorization has been denied, the inpatient shall be responsible for the full amount of the bill.

(4)No Medicaid or third party payor. Inpatients having no Medicaid or third party payor shall be expected to pay the full amount of the bill. If a household believes they can not afford to pay the full amount, they may request, to apply for a payment plan or fee reduction. If the household still feels they can not pay the fees in accordance with the reduced rate, they may contact the Director, listing the reason(s) they can not meet their obligation and request a fee waiver.

(5)Therapeutic services contracts. The Center may additionally enter into contractual agreements with a third party to provide therapeutic services. These individual agreements shall specify the negotiated amounts for services rendered.

(6)Charity beds. The Center shall provide charity care not to exceed 10% of utilized beds. The legal guardian shall be notified in advance if admission will be as charity care status. Charity care inpatients shall otherwise meet admission and continued stay requirements. If it is determined that an inpatient should be discharged for failure to meet admission and continued stay requirements and the legal guardian shall be provided a written notice that the full daily rate shall be charged for each day the person remains at the Center.

(b)Outpatients.

(1)General. The Center shall bill and attempt to collect fees for all outpatient services rendered. Upon admission, the outpatient or legal guardian shall provide all information necessary to collect payment from third party payors if applicable. All co-pays shall be paid on the date the service is rendered.

(2)Medicaid. Medicaid shall be filed and accepted as payment in full for those Medicaid eligible outpatients except for Medicaid spend-downs that are the outpatient's responsibility.

(3)Third party payor(s). Claims shall be filed with third party payors in accordance with appropriate procedures. In cases where the third party payor does not cover the full amount of the bill, the outpatient shall be responsible for the remaining amount. IN cases where an outpatient requests services that are not covered or for which authorization has been denied, the outpatient shall be responsible for the full amount of the bill.

(4)No Medicaid or third party payor. Outpatients having no Medicaid or third party payor shall be expected to pay for services on the date they are entered. If a household believes they can not afford to pay the the full amount, they may request, to apply for a payment plan or fee reduction. If the household still feels they can not pay the fees in accordance with the reduced rate, they may contact the Director, listing the reason(s) they can not meet their obligation and request a fee waiver.

(c)Respites.

(1)Medicaid. The fees for Medicaid eligible inpatients are paid through a grant with the Department of Human Services.

(2)Non-Medicaid. Inpatients are responsible for a percentage of the fees based on a sliding fee scale. A co-pay shall be paid prior to admission.

(d)Bill conflicts. Any person having a conflict with a patient bill may contact the Finance Office for resolution. In the event that the conflict can not be resolved by the Finance Office, the information shall be forwarded to the Director for resolution. If the conflict can not be resolved satisfactorily, a grievance may be filed.

Okla. Admin. Code § 130:12-9-1

Added at 19 Ok Reg 2598, eff 7-11-02; Amended at 27 Ok Reg 2458, eff 7-25-10