· ANGELS will pay for satisfactory provided services rendered in accordance with the provisions below. Payments are based on the number of units specified in the service plan.
· All providers may only use the units designated for their specific use, in the amount, scope, frequency, and duration outlined in the service plan. Each service may only be provided for the time span listed for that service. Providers who bill beyond the approved amount, scope, frequency, or duration WILL NOT BE PAID FOR SERVICES rendered and that family is NOT RESPONSIBLE for payment if payment cannot be collected due to inappropriate billing. You must have written authorization in order to document that you have authorization of services.
· It is the responsibility of the provider to make sure that enough units are available to last each client the ENTIRE SERVICE PLAN YEAR! Even with a fluctuation statement, a provider may not use an excessive amount of units that leaves a client not able to get their needs met throughout the year or to significantly reduce utilization to make the units "stretch." If the provider neglects this duty the provider is responsible for providing the services for the remainder of the service plan, without reimbursement or to reimburse the service plan the dollar amount needed to fund the remaining of the service plan for the units that were over utilized otherwise this would be considered fraud.
· If there is a special circumstance that requires a mass amount of units be used and the family wishes to change the expectation of services being available throughout the entire year, the provider, case manager, family, and the contract holding agency must all be made aware, agree, and have written documentation to the fact.
· Providers shall comply with all ANGELS billing procedures and requirements, which may be amended by ANGELS.
· All submissions of required documentation in order to maintain funding sources, remain in compliance with the State of Colorado rules and regulations, and ANGELS policies and procedures including needed documentation for client and provider file alike.
The Office of the Inspector General (OIG) has identified the following areas in which fraud frequently occurs amount home health agencies. Employees, clients and affiliates must be aware of what they consist of and take care to avoid them:
1. Services Not Rendered: ANGELS cannot bill for services not actually rendered. Billing for services not actually rendered involves submitting a claim that represents the provider performed a service that all or part of which was simply not performed at the time stated.
2 Medically Unnecessary Services: ANGELS cannot bill for medically unnecessary services. Billing for medically unnecessary services involves knowingly seeking reimbursement for a service that is not warranted by the client's current and documented medical condition.
3 Duplicate Billing: Duplicate billing occurs when the home health agency submits more than one claim for the same service; bills for multiple services at the same time; or a bill is submitted to more than one primary payer at the same time. ***Sone services are specifically designed to allow assistance during medical appointments such as mentorship and personal care.
4 Unqualified Personnel: ANGELS cannot bill for services for which the provider is unqualified or unlicensed to perform If a license or qualification lapses; then alternate, licensed personnel must perform the visit
5 Misapplying Funds Providers and clients shall not steal, embezzle or otherwise convert to the benefit of another person, or intentionally misapply any funds, money, premiums, credits or other assets of a provider of any healthcare benefit program; including Medicare, Medicaid or a private payer.
If a anyone client or provider, is found to be engaging in fraudulent documentation; ANGELS will report such actions to the proper authorities, seek financial restitution and reserves the right to discipline the employee up to termination, contract remediation or termination, and/or discharge a client
· Pay all associate fees, including but not limited to fines, court costs, etc.
· Pay a 20% fee of all billed services in order for services to be audited for further fraud.
· Over Payment
Refunding of Payments ANGELS shall promptly refund any payments made by state or federal agencies or private payers which were made erroneously and of which ANGELS was aware. If a collaborator realizes or discovers that documentation was submitted with incorrect information that may result in an overpayment, they must immediately notify ANGELS.
· In the event that overpayments are made by the ANGELS due ANGELS error, omission, error, fraud, or in the event that the State or Federal government seeks to recover from ANGELS any sums of money based upon a claim on behalf of a collaborator, the collaborator shall immediately reimburse such funds to ANGELS in accordance with the Medical Assistance Act, C.R.S., Section 26-4-112, or as otherwise allowed by law.
· The parties understand and agree that ANGELS shall have the right to offset against payments due to the Collaborator hereunder, or by other legal means recover any debts owed by the Collaborator to the CCB or to the State.
· Any amounts which have been paid by ANGELS and which are found to be improper in accordance with the terms of this contract shall be immediately returned to ANGELS, or may be withheld from future payments.
· Collaborators must provide tools to be able to access documentation in addition to providing services, such as but not limited to, the ability to access the internet securely, etc.
· ANGELS shall receive, on behalf of Collaborators, all payments and payment transmittal documents from Medicaid and the State of Colorado or relevant agent. ANGELS shall release the funds for all reimbursable services the last business day of the month following the month service was provided. No payments shall be due from ANGELS to the Contractor unless the funds for such payments are received by ANGELS
· Outside forms are permissible. Forms must have all information that is mandated in order to bill and meet rules and regulations including verification policy. There is an additional 10 % fee per month for providers who submit documentation in alternative methods.
Rate sheets are published here: http://www.watchingfish.com/rates . Rates may be amended.
BAA and HIPAA
https://www.watchingfish.com/business-associate This is a link to the business associate agreement that all collaborators are bound by. It means you are personally responsible for safeguarding all client information and are responsible for the consequences if you compromise information.
I understand that I am responsible for complying with the HIPAA policies and regulations.
I Will treat all Information received, which relates to the patients of the provider, as confidential and privileged Information.
I will not access patient information unless I have the need to know this information in order to perform my job.
I will not disclose Information regarding the Provider's patients to any person or entity other than as necessary to perform my job, and as permitted under the HIPAA Policies.
I Will not log on to any of the Provider's computer systems that currently exist or may exist in the future unless I am instructed to do so by the Privacy Officers.
I Will not use e-mail to transmit consumer information unless I am instructed to do so by the ANGELS or client's have given permission in writing.
I will not take patient Information from the premises of the Provider in paper or electronic form without first receiving permission from the ANGELS
Upon separation from ANGELS, I agree to continue to maintain the confidentiality of any information I learned while associated with ANGELS, I agree to turn over any keys; access cards, or any other device that would provide access to the provider or Its information.
· Please note, accessing confidentially information on a public Wi-Fi source is a violation of HIPPA
I understand that violation of this agreement could result in my termination, effective immediately and a report to authorities.