Billing and Coding

  • Nyack Hospital is committed to full compliance with all rules and regulations of government healthcare programs, including Medicare and Medicaid. Nyack Hospital also complies with the rules and requirements of all commercial insurance programs.
  • Nyack Hospital will bill for eligible services that are rendered, appropriately documented and consistent with the medical necessity guidelines provided by the insurance company.
  • To ensure accurate coding and billing we train all staff, clinicians, coders and billers on proper coding, charge capture and billing. We also update our Charge Description Master (CDM) and have developed systems to prevent false and inaccurate claims.
  • Employees involved in billing and coding are expected to be knowledgeable in all aspects of current laws and regulations affecting their duties. They must take all reasonable steps to ensure their work is accurate, timely, supported by the medical record and compliant with applicable laws and regulations.

Billing Questions or Conflicts

  • If you have direct knowledge of any billing errors or improprieties, or if you suspect that an individual’s conduct with regard to billing practices is in direct violation with established hospital policies, report this suspicion to your immediate supervisor or to the Director of Corporate Compliance. The matter will be promptly investigated and any problems corrected if errors in claims or billings are found.

As part of our commitment to full compliance, we do not:

  • bill for items and services not rendered or medically necessary;
  • misrepresent the type of level of service rendered;
  • bill for non-covered services;
  • inappropriately unbundle services;
  • bill for services rendered by other providers; or
  • misrepresent a diagnosis in order to obtain payment.

 

.