Chapter 4 Billing Generally
RULES FOR HOSPITALS
There is little in the Nevada Revised Statutes to provide physicians specific guidelines regarding billing procedures. The NRS focus mostly on the policies and procedures followed by hospitals. Nevertheless, there are certain restrictions and requirements to which all health care providers must adhere when billing for services. This chapter summarizes those key points and highlights the statutory guidelines provided solely for hospitals.
Nevada law requires that every patient be given the opportunity to examine the bill for his care and receive an explanation of the bill, whether or not he is personally responsible for payment of the bill. NRS 449.710(7). The patient should understand the bill he is receiving. Many patients perceive the cost of medical care to be very high. The more the patient understands the charges, the less likely it is that there will be confusion or claims of inflated costs. The patients statutory right to examine and understand his bill places a burden on the physician to ensure that the billing statement is accurate. Although the right of the patient to review his or her bill is protected, the right of the physician or care giver to make a mistake with the billing is not. The legislature in Nevada has dedicated an entire chapter of laws to restraining the cost of health care. NRS 439B. One of the stated purposes of this body of law, is to reduce excessive billed charges and revenues generated by some hospitals in this state. NRS 439B160(2). Taken in tandem with the other provisions of the Code discussed in this chapter, the message is clear — billings for medical services are receiving increased scrutiny, and physicians and hospitals need to ensure compliance with the law.
There is, however, one general guideline to assist physicians and other care givers as they attempt to fulfill their responsibilities with regard to billings. NRS 629.071 outlines the items to be included in a bill to a patient by each provider of health care. This law mandates all bills to include an itemized list of all charges for services, equipment, supplies and medicines provided the patient. The statute requires the bill to be in terms which the patient is able to understand, and requires the bill to be timely provided, at no additional cost to the patient.
RULES FOR HOSPITALS
Most of the statutes addressed to billing apply primarily to hospitals. To the extent a requirement imposed on a hospital makes sense for practicing physicians as well, Nevada physicians should take note.
Under NRS 439B.400, each hospital in the state must maintain and use a uniform list of billed charges for that hospital, and cannot charge different rates for different inpatients. The major exception to this rule, however, permits the hospital and to negotiate discount rates or modified payment plans with patients and other payors. The Department of Human Resources publishes an annual list of all hospitals with their respective charges for services. NRS 439A.106. In this way, the department attempts to keep medical costs competitive by spelling out what each hospital charges for the same or similar services. Hospitals licensed under Chapter 449 must, in most cases, itemize billings on a daily basis, with specificity:
- All charges for services
- All charges for equipment
All charges for supplies and medicines provided.
A hospital acting as the billing agent for a physician that performs services in the hospital, may not add onto the bill additional charges related to the cost of processing the bill. NRS 439B.420(6).
In Nevada, hospitals may use the Uniform Billing and Claim Form, established by the American Hospital Association. NRS 449.243. This form must be accepted by insurers under a health insurance contract, NRS 689B.105, a group health insurance contract, NRS 689B.250, as well as every state agency. NRS 689B.250. This applies to non-profit hospitals as well as for-profit hospitals. NRS 695B.285.
There are special patients for whom the hospital may or must make special accommodations regarding billings and costs. Under NRS 439B.260, a major hospital shall reduce its charges by at least 30% for patients that:
- Have no insurance or other contractual arrangement for payments by a third party;
- Are not covered by either a state or federal program that would pay the charges; and
- Makes reasonable arrangements, within 30 days of discharge, to pay for the charges.
In addition, major hospitals must reduce by 30% outpatient pharmacy billings for those qualified patients on Medicare. NRS 439B.260.
A similar provision in NRS 450.420 addresses indigent patients and patients requiring charity. Under 450.420, the board of county commissioners may, for public hospitals in their county, determine which patients classify as charity or indigent patients, and may set charges that the commission deems appropriate. This is true for emergency services as well as in-patient/out-patient treatment. The obvious intent of this and similar provisions, is to allow some degree of variation in billings for patients deemed to be in a special class.
Finally, for laboratories conducting cytologic examinations of gynecologic specimens, there are special billing rules. Bills are to be submitted to the patient directly, or to a responsible insurer or other third party payer, or to the hospital or clinic. Bills may not to be sent to the physician directing the examination. In fact, with the exception of the situations detailed in NRS 652.195(3), physicians cannot charge for cytologic services relating to gynecologic exams. NRS 652.195.
The Nevada Revised Statutes contain only a limited number of rules regarding physician billing, and these are fairly general in nature. Guidelines and statutes for hospitals are moderately more specific. Specificity, clarity, and timeliness are the hallmarks of enforceable billings.