I am in need of clarification!!! This is the scenario for outpatient CMHC claims: When writing off a patient balance to bad debt, my current protocol is this: Bill claim to Medicare, receive payment from Medicare, claim will then cross over to secondary, if applicable. Once payment from primary and secondary (if applicable) is received, balance is then billed to patient. Statement for balance due then sent to patient. When Exhibit 5 is completed, the date the first invoice/statement is sent to patient is recorded as well as all payment dates. 120 day requirement begins with 1st patient invoice/statement date, unless subsequent payment(s) are received, at which 120 day requirement starts again with most recent payment date.
However, I am being told that Medicare Guidelines state first invoice is to be sent to patient upon discharge, regardless of when the first claim was submitted for reimbursement. Now, for those who bill for CMHC claims, it is not unlikely to have a patient with an admission date and discharge date with a 6 month interval. So, based upon the information that I am being provided, the invoice for the 1st claim does not have to be sent until the patient is discharged. This does not make any sense to me and I would love to get some feedback!