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Guides
- Alabama medical billing guideAlabama 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.
- Arizona medical billing guideArizona 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.
- Arkansas medical billing guideArkansas 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.
- California medical billing guideA 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.
- Colorado medical billing guideColorado 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.
- Connecticut medical billing guideConnecticut 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.
- Florida medical billing guideLicensed 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.
- Georgia medical billing guideUnder 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.
- Idaho medical billing guideUnder 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.
- Illinois medical billing guideUnder 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.
- Indiana medical billing guideIndiana 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.
- Iowa medical billing guideIowa 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.
- Kansas medical billing guideKansas 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.
- Kentucky medical billing guideKentucky 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.
- Louisiana medical billing guideLouisiana 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.
- Maine medical billing guideMaine 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.
- Maryland medical billing guideMaryland 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.
- Massachusetts medical billing guideMassachusetts 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.
- Michigan medical billing guideMichigan'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.
- Minnesota medical billing guideMinnesota 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.
- Missouri medical billing guideMissouri'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.
- Montana medical billing guideMontana 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.
- Nebraska medical billing guideNebraska 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.
- Nevada medical billing guideNevada 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.
- New Hampshire medical billing guideNew 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.
- New Jersey medical billing guideNew 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.
- New Mexico medical billing guideNew 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.
- New York medical billing guideNew 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.
- North Carolina medical billing guideNorth 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.
- North Dakota medical billing guideNorth 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.
- Ohio medical billing guideUnder 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.
- Oklahoma medical billing guideOklahoma'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.
- Oregon medical billing guideOregon 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.
- Pennsylvania medical billing guidePennsylvania'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.
- Rhode Island medical billing guideRhode 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.
- South Dakota medical billing guideSouth 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.
- Texas medical billing guideA 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.
- Utah medical billing guideUtah 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.
- Virginia medical billing guideVirginia 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.
- Washington medical billing guideWashington 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.
- West Virginia medical billing guideWest 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.
- Wisconsin medical billing guideWisconsin 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.
Glossary
- What are duplicate charges on a medical bill?A duplicate charge is when the same service, item, or billing code appears more than once on your bill for the same date — so you are charged twice for one thing. It often happens by accident when systems re-enter a line, and it is one of the most common medical-billing errors to check for.
- What are EOB-rejected charges on a medical bill?An EOB-rejected charge is a line your insurer's Explanation of Benefits did not cover — denied, disallowed, or applied to a contractual adjustment — that a provider then still bills to you. Your EOB is not a bill; comparing it to the provider's bill shows which charges you may not actually owe.
- What are missing financial-assistance discounts on a medical bill?A missing financial-assistance discount is when you qualified for a hospital's charity-care or financial-assistance program but the discount was never applied to your bill. Nonprofit hospitals must maintain a written financial-assistance policy, and patients are often billed full charges without being screened for the help they were eligible to receive.
- What are self-pay overcharges on a medical bill?A self-pay overcharge is when an uninsured or cash-paying patient is billed more than a hospital's posted standard or discounted cash price for the same service. Federal price-transparency rules require hospitals to publish these prices, so you can compare what you were billed against what the hospital says the service should cost.
- What is code-pair bundling on a medical bill?Code-pair bundling is when two procedure codes that federal coding rules say should be billed together as one are instead billed separately, which can raise your total. Medicare's coding edits list specific code pairs that normally should not be reported on the same day for the same patient.
- What is upcoding on a medical bill?Upcoding is when a bill uses a code for a more expensive or more severe service than the care you actually received. Because the code drives the price, an inflated code inflates the charge. Comparing the codes on your itemized bill to what happened in your visit can reveal a mismatch.