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Get to knowDetailed guide to Kansas
Medical billing in Kansas is governed by several laws and regulations. Here are the detailed guidelines and laws:Kansas Health Care Prompt Payment Act
- Applicability:
- The Kansas Health Care Prompt Payment Act applies to fully-insured health plans, including plans offered by HMOs, individual or group major medical plans, hospital/surgical policies, and dental plans.
- The law does not cover self-insured employer plans, Medicare and Medicare supplement policies, Medicaid, workers' compensation, federal employee plans, vision or drug plans, and disability income.
- Payment Timelines:
- Insurers have 30 days to pay a clean claim or send a notice stating the reason for delay or denial.
- If additional information is requested, the insurer has 15 days to pay or deny the claim after receiving the required information.
- Interest Accrual:
- Failure to comply with the payment timelines results in the accrual of interest equal to 1% per month of the billed charges, payable to the provider, individual, or entity submitting the claim.
Kansas Administrative Regulations
- Medical Bills and Reports:
- Physicians must notify the employer or carrier promptly after completing treatment and submit final bills forthwith.
- Bills should be itemized, showing the date and charge for services rendered.
- In cases requiring prolonged treatment, physicians should submit partial bills, fully itemized, at intervals of at least 60 days.
- Medical Reports:
- Physicians must submit medical reports on a periodic basis, depending on the nature and severity of the injuries involved, and immediately upon request by the employer, insurance carrier, or employee.
- Reports should include information about the patient's medical history and any examinations or treatment provided.
- Nursing Care:
- Nurses, whether registered or practical, should be furnished in an institution or the worker's home if recommended by the treating doctor.
No Surprises Act
- Protection Against Surprise Bills:
- The federal No Surprises Act protects patients from surprise bills for emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities, effective January 1, 2022.
- Patients are only responsible for in-network cost-sharing amounts for these services.
- Balance Billing:
- Out-of-network providers may balance bill patients for the difference between the provider's charges and the patient's plan benefits, but this is limited by the No Surprises Act.
Additional Resources
- Kansas Hospital Association:
- The Kansas Hospital Association provides resources and information on the No Surprises Act, including guidelines for hospitals and healthcare providers.
These laws and regulations outline the guidelines and timelines for medical billing in Kansas, including the requirements for prompt payment, interest accrual, and the protection against surprise bills.