N.J. Admin. Code § 13:44K-8.9

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:44K-8.9 - Claims submissions forms

(a) No licensee shall submit any claim, bill, or governmental assistance claim to a third-party payor or employer for occupational therapy services rendered to any client that involves dishonesty, fraud, deception, or misrepresentation.

(b) No licensee shall submit to a third-party payor or employer any claim, bill, or governmental assistance claim, which contains any of the following:

1. Any treatment date, which does not accurately reflect the date when the services were actually provided;

2. Any description of an occupational therapy service, which does not accurately reflect the actual service provided;

3. Any statement material to the claim, which is known to be false or misleading; or

4. A charge for any service the amount of which has been advertised as free or complimentary or for an amount that exceeds the advertised charge for discounted services.

(c) A licensee who provides occupational therapy services to a client enrolled in any insurance plan with co-payment features and who intends to waive any part of the co-payment or all of the co-payment by the client shall, when submitting any claim or bill to the third-party payor, conspicuously disclose on the face of the claim or bill in a legible manner, or in the electronic claim submission, that the co-payment, or a portion of the co-payment, has not or will not be billed to, or collected from, the client.

(d) The accuracy of all information contained in written or electronic submissions to a third-party payor or employer, including pre-determinations, claims, bills, or governmental assistance claims, shall be the personal responsibility of the licensee whose name, license number, or signature appears on the signature line of the claim. In the case of electronic claims the licensee identified as the provider shall be held responsible for the accuracy of the information whether or not said licensee actually completed the claim. The Council shall presume that the licensee identified on the claim reviewed its contents and approved its submission. It shall not be a defense to an allegation of a violation of this section that the claim was completed or submitted by an agent of the licensee.

(e) All insurance records shall be maintained pursuant to the provisions of N.J.A.C. 13:44K-10.

N.J. Admin. Code § 13:44K-8.9

Amended by 51 N.J.R. 769(b), effective 5/20/2019