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Guías de facturación
- Guía de facturas médicas de AlabamaAlabama directs a hospital or nursing home to furnish the patient an itemized statement, in language an ordinary layman can understand, detailing the charges and expenses incurred, broken down by department into their constituent components with unit-price rate data; a more detailed statement must be provided on written request.
- Guía de facturas médicas de ArizonaArizona directs a health care facility that receives a direct payment to give the payer a receipt stating the amount paid, the applicable procedure and diagnosis codes for the services rendered, and a clear notation that the services were subject to direct payment.
- Guía de facturas médicas de ArkansasArkansas directs every hospital in the state, except those the State operates, to furnish the patient and the patient's insurer, on request, an itemized listing of all services, drugs, and supplies billed, no later than thirty days after discharge, and to advise each patient in writing at discharge of the right to receive it.
- Guía de facturas médicas de CaliforniaA California hospital must, upon a patient's request, provide an itemized statement, written in plain language, describing each item of service and the charge for it.
- Guía de facturas médicas de ColoradoColorado directs hospitals and providers, beginning July 1, 2024, to follow industry-standard billing practices on every patient bill. Each bill must state, at a minimum, the date of service, the patient's name, the provider's name, a description of the services provided, and the charge for each service.
- Guía de facturas médicas de ConnecticutConnecticut directs hospitals to include a conspicuous notice on admission forms that a self-pay patient may request a copy of the hospital's charges, and, on request, to provide the self-pay patient an itemized bill within thirty days that identifies, in plain language, each individual service, supply, or medication and its specific charge.
- Guía de facturas médicas de FloridaLicensed Florida facilities must, on request, furnish the patient a plain-language, itemized statement of charges detailing each specific service and its charge, enabling the patient to identify billing errors.
- Guía de facturas médicas de GeorgiaUnder Georgia's Fair Business Practices Act, a hospital or long-term care facility must deliver to a discharged inpatient (or their legal representative) an itemized statement of all charges for which the patient or a third-party payor is being billed, no later than six business days after discharge; failing to do so is designated an unlawful practice enforceable by the Georgia Attorney General's Consumer Protection Division.
- Guía de facturas médicas de IdahoUnder the Idaho Patient Act, before a provider or facility may take extraordinary collection action it must first send the patient a final notice, and that notice must state that a full itemized list of the goods and services provided to the patient is available on the patient's request.
- Guía de facturas médicas de IllinoisUnder the Illinois Fair Patient Billing Act, a hospital that bills a patient must provide an itemized statement of charges for the inpatient and outpatient services it rendered upon receiving a request from the patient, and each hospital bill must carry notice that the patient may obtain that itemized statement.
- Guía de facturas médicas de IndianaIndiana directs a provider facility, when an individual for whom a nonemergency health care service has been ordered, scheduled, or referred requests it, to provide a good-faith estimate of the price the facility will charge. The facility must provide the estimate within five business days and may not charge for it; the estimate is non-binding and valid for thirty days.
- Guía de facturas médicas de IowaIowa directs any health care provider to provide requested records within thirty days of a patient's written request, and separately to furnish the patient, the patient's legal representative, or the patient's attorney one free copy of the patient's complete billing statement, charging only the actual cost of postage or delivery.
- Guía de facturas médicas de KansasKansas hospital licensing regulation directs every licensed hospital to maintain policies and procedures ensuring patient rights, including that each patient has the right to examine and receive a detailed explanation of the patient's bill, for both inpatients and outpatients.
- Guía de facturas médicas de KentuckyKentucky directs each health facility, when a paying patient requests a copy of an itemized statement, to furnish one free copy within thirty days of discharge or fifteen days of the request, whichever is later. Each invoice must note that an itemized statement may be obtained on request, and the facility must make staff available to explain the listed charges.
- Guía de facturas médicas de LouisianaLouisiana directs each hospital licensed by the Louisiana Department of Health to have an itemized statement of billed services available no later than ten business days after a patient's discharge, to make patients aware of its availability before discharge, and to provide an interim statement when the patient or an authorized agent requests one.
- Guía de facturas médicas de MaineMaine directs each licensed hospital to notify patients in writing at discharge that an itemized bill is available on request, and to provide the itemized bill within 30 days of a request; the request may be made at discharge or any time within seven years afterward.
- Guía de facturas médicas de MarylandMaryland directs hospitals to give each patient a summary financial statement within 30 days after discharge and, on the patient's request made within one year of receiving that summary, to provide an itemized financial statement within 30 days that briefly but clearly describes each item and the amount charged. A hospital that fails to provide a required itemized statement is subject to a $300 fine.
- Guía de facturas médicas de MassachusettsMassachusetts directs every licensed facility where billing applies to furnish a patient, upon reasonable request, an itemized bill reflecting laboratory charges, pharmaceutical charges, and third-party credits, and to allow the patient to examine an explanation of that bill regardless of the source of payment.
- Guía de facturas médicas de MichiganMichigan's Public Health Code requires each licensed health facility to adopt and follow a patient rights policy that entitles a patient to receive and examine an explanation of the bill regardless of the source of payment, and to receive, on request, information about the facility's financial assistance.
- Guía de facturas médicas de MinnesotaMinnesota directs a hospital to screen a patient for eligibility for charity care and other health coverage or assistance in connection with the patient's bill, and to attempt to complete the charity-care screening in person or by telephone within 30 days after the patient receives services; related sections limit collection actions where the screening duty is unmet.
- Guía de facturas médicas de MissouriMissouri's Health Care Cost Reduction and Transparency Act directs health care providers to furnish a written estimate of the cost of a particular service, imaging procedure, or surgery when a patient submits a written request that includes a treatment plan from the patient's provider, within three business days of the request.
- Guía de facturas médicas de MontanaMontana directs a hospital, clinic, surgical center, or other health care provider, on a patient's or agent's request, to disclose its good-faith estimated charge for a health care service or course of treatment expected to exceed $500, either when the service is scheduled or within 10 business days of the request.
- Guía de facturas médicas de NebraskaNebraska directs a health care facility or health care practitioner facility to provide an itemized billing statement, including diagnostic codes, when a patient or the patient's representative submits a written request, at no charge and within fourteen days of the request.
- Guía de facturas médicas de NevadaNevada directs a health care entity, before taking any action to collect a medical debt, to give the patient an easy-to-understand itemized statement of the debt that includes the applicable billing codes and modifiers for each item or service, to identify a contact who can correct it, and to provide an itemized receipt within 30 days after any payment.
- Guía de facturas médicas de New HampshireNew Hampshire directs medical-service providers who receive payment from a third party, including licensed hospitals, to provide the patient an itemized statement of services, dates, and costs within thirty days, or to send a non-itemized bill only if it states in large, easily readable print that an itemized bill will be submitted free of charge on request.
- Guía de facturas médicas de New JerseyNew Jersey directs a licensed hospital, on a patient's written request, to furnish a legible paper or electronic copy of the patient's medical or billing records, or both, within 30 days, and caps the fees a hospital may charge for them.
- Guía de facturas médicas de New MexicoNew Mexico directs health care facilities, third-party providers, and medical creditors to ensure every bill sent to a patient contains a complete, plain-language description of the date, amount, and nature of all charges, along with the patient's insurance-verification and financial-assistance screening status.
- Guía de facturas médicas de New YorkNew York's Patients' Bill of Rights regulation directs every general hospital to afford patients the enumerated rights, which include receiving an itemized bill and an explanation of all charges, and to adopt and honor those rights for inpatients, outpatients, and emergency-service patients.
- Guía de facturas médicas de North CarolinaNorth Carolina directs all licensed hospitals and ambulatory surgical facilities to present, upon the patient's request, an itemized list of charges in language comprehensible to an ordinary layperson. A bill that is not itemized must notify the patient of the right to request an itemized bill free of charge.
- Guía de facturas médicas de North DakotaNorth Dakota directs a health care provider, upon a patient's signed written request for medical records or medical bills, to provide the medical records and any associated medical bills in paper, facsimile, or electronic form, subject to a capped per-page copying fee.
- Guía de facturas médicas de OhioUnder Ohio's Hospital Care Assurance Program, a participating hospital must provide, without charge, basic medically necessary hospital-level services to Ohio residents who are not Medicaid recipients and whose income is at or below the federal poverty line, and its bills must carry a written statement about that assistance.
- Guía de facturas médicas de OklahomaOklahoma's statutory patients' rights list directs hospitals to afford each patient treated in the state the right to examine and receive an explanation of his or her bill regardless of the source of payment, as one enumerated right within a broader statutory bill of rights.
- Guía de facturas médicas de OregonOregon directs a licensed hospital to screen a patient for presumptive eligibility for financial assistance, including charity care, when the patient is uninsured, is enrolled in the state medical assistance program, or owes the hospital more than $500, and to apply any qualifying assistance to the bill before sending it. A patient may also apply for financial assistance up to twelve months after paying for the services.
- Guía de facturas médicas de PennsylvaniaPennsylvania's hospital patient bill of rights regulation directs each licensed hospital to implement written patient rights that include the patient's right to examine and receive a detailed explanation of the bill, and to provide information and counseling on financial resources for care.
- Guía de facturas médicas de Rhode IslandRhode Island's patient-rights statute directs licensed health-care facilities to provide each patient a summarized medical bill within thirty days of discharge and, on request, to furnish the patient an itemized copy of the bill.
- Guía de facturas médicas de South DakotaSouth Dakota directs a health care provider or facility to disclose all fees and charges for health care procedures when a patient asks; the duty is triggered by the patient's request and is not limited to any particular format.
- Guía de facturas médicas de TexasA Texas hospital must provide, on request, an itemized statement of the billed services and, if requested, information on whether the hospital has a financial-assistance policy.
- Guía de facturas médicas de UtahUtah directs hospitals, including ambulatory surgical facilities and general acute and specialty hospitals, to provide a statement of itemized charges to any patient who receives care, itemizing each charge actually provided, at the hospital's expense after it receives the insurer's explanation of benefits.
- Guía de facturas médicas de VirginiaVirginia directs any health care provider licensed or certified by a board within the Department of Health Professions to provide, upon a patient's request, an itemized statement of the charges for services rendered, regardless of whether a bill has been or will be submitted to any third-party payor.
- Guía de facturas médicas de WashingtonWashington requires health care providers and facilities to furnish a patient, on request, an estimate of the fees and charges for a specific service, visit, or stay, along with information about other fees the patient may incur; a hospital may satisfy this with a statement and contact information.
- Guía de facturas médicas de West VirginiaWest Virginia directs licensed hospitals and similar institutions to supply, on a patient's request, one itemized statement describing with specificity each service or medication for which a charge is assessed, at no additional cost, for both inpatient and outpatient services.
- Guía de facturas médicas de WisconsinWisconsin directs health care providers, including hospitals, to provide a patient or an authorized person copies of the patient's health care records on request, upon informed consent and payment of statutorily capped fees. The statutory definition of patient health care records expressly includes billing statements and invoices for treatment or services.
Glosario
- ¿Qué es la agrupación de pares de códigos en una factura médica?La agrupación de pares de códigos es cuando dos códigos de procedimiento que las reglas de codificación federales dicen que deben facturarse juntos como uno se facturan en su lugar por separado, lo cual puede aumentar tu total. Los edits de Medicare enumeran pares de códigos específicos que normalmente no deben reportarse el mismo día para el mismo paciente.
- ¿Qué es la sobrefacturación (upcoding) en una factura médica?La sobrefacturación es cuando una factura usa un código para un servicio más caro o más grave que la atención que realmente recibiste. Porque el código impulsa el precio, un código inflado infla el cargo. Comparar los códigos en tu factura detallada con lo que pasó en tu visita puede revelar una discrepancia.
- ¿Qué son cargos duplicados en una factura médica?Un cargo duplicado es cuando el mismo servicio, artículo, o código de facturación aparece más de una vez en tu factura para la misma fecha — así que se te cobra dos veces por una cosa. A menudo ocurre por accidente cuando los sistemas reingresan una línea, y es uno de los errores de facturación médica más comunes para verificar.
- ¿Qué son cargos rechazados por EOB en una factura médica?Un cargo rechazado por EOB es una línea que tu asegurador en su Explicación de beneficios no cubrió — rechazado, desautorizado, o aplicado como ajuste contractual — que un proveedor luego aún te factura. Tu EOB no es una factura; compararlo con la factura del proveedor muestra qué cargos es posible que en realidad no debas.
- ¿Qué son descuentos de asistencia financiera faltantes en una factura médica?Un descuento de asistencia financiera faltante es cuando calificaste para un programa de atención caritativa o asistencia financiera de un hospital pero el descuento nunca se aplicó a tu factura. Los hospitales sin fines de lucro deben mantener una política escrita de asistencia financiera, y a menudo los pacientes se facturan cargos completos sin ser examinados para la ayuda que eran elegibles de recibir.
- ¿Qué son sobrecargos para pagadores de efectivo en una factura médica?Un sobrecargo para pagadores de efectivo es cuando a un paciente sin seguro o que paga en efectivo se le factura más que el precio de efectivo estándar o con descuento publicado de un hospital para el mismo servicio. Las reglas federales de transparencia de precios requieren que los hospitales publiquen estos precios, así que puedes comparar lo que se te facturó con lo que el hospital dice que el servicio debería costar.