AGENCY: Box Elder County (Utah). Pioneer Care Center
SERIES: 4461
TITLE: Medicare billing case files
DATES: 1994.
ARRANGEMENT: Chronological, thereunder alphabetical by patient name
DESCRIPTION: These files document the actual billings submitted to Medicare and payments received for services rendered to patients covered by Medicare. The care center bills Medicare for the total amount owed. There are two types of billings. Medicare A are billings for patients transferred from hospitals, and Medicare B are billings for patients receiving only physical therapy.
Both types of files include a receipt to Medicare (including receipt number, date, amount received, purpose of payment, form of payment and signature); a check stub for Medicare payment (includes provider number, date, and amount); a computer printout of a detailed spread sheet of all charges (includes date of payment, page number, bill number, date of service, batch number, and totals); copies of the institution's patient billings (includes patient's name, home address, and date of birth, date of admission, and dates of service, description of expenses, services, and totals, Medicare payments, amounts due, social security number, principal code, and diagnosis description); and Blue Cross and Blue Shield provider vouchers (includes account number, patient's name, contract of service, procedures, amount billed, amount paid, total billed amount, and net payments).
The files also include a level of care form (includes name of provider, name of attending physician(s), patient's name and date of birth, admission date, indication whether form used for submittal on admission, periodic report as requested, or change in level of care and effective date, a summary of skilled nursing care needed and frequency (weekly, daily, other), diagnosis, physical therapy, overall condition, date, signature of reporting nurse); and handwritten journal entries of totals for accounts receivable indicating the amount billed per patient per payment source (Medicare and Medicaid).
RETENTION
DISPOSITION
RETENTION AND DISPOSITION AUTHORIZATION
Retention and disposition for this series were specifically approved by the State Records Committee.
APPROVED: 12/1990
FORMAT MANAGEMENT
Paper: Retain in Office for 5 years and then destroy.
APPRAISAL
Administrative
This disposition is based on the administrative needs expressed by the care center's administrator and the requirements established by the State Division of Health Care Financing. The facility cost profile report (series 4469) requires the center "to keep for a period of 5 years such records as necessary to disclose fully the information contained herein."