Training Module — New Hire 10: Billing Integrity (Brief)

Policy Reference: NC-15 — Billing & Financial Compliance

Learning Objectives

By the end of this module, you will be able to:

1. Explain the connection between accurate documentation and billing.
2. Identify three documentation behaviors that can create billing problems.
3. Describe the service agreement and your role in it.
4. State the agency's policy on patient financial transactions.
5. Recognize the billing-related reasons why clock-in/clock-out accuracy matters.

Key Points

Documentation = Billing
Noble Care cannot bill for services that are not documented. Every visit note you complete is the direct evidence that services were rendered. This means:

• If you provide care but don't document it → the agency loses revenue
• If you document care that wasn't provided → that is fraud
• If you document the wrong times → it either understates or overstates what was done

Your visit notes must accurately reflect exactly what occurred.

Service Agreement
Every Noble Care patient signs a Service Agreement before care begins. This document includes:

• The specific services authorized
• The hourly rate and billing schedule
• Cancellation policy
• The patient's payment responsibilities

The Service Agreement defines the scope of your work. Providing services not listed in the Agreement without supervisor authorization can create billing and liability problems.

Clock-In / Clock-Out Accuracy
Noble Care bills based on documented service time. Your clock-in and clock-out times must reflect:

• When you actually arrived at the patient's home (not the parking lot or the street)
• When you actually completed the visit and left

Do not clock in early or clock out late to inflate hours. This constitutes billing fraud and is grounds for immediate termination.

No Financial Transactions with Patients
You may never:

• Handle a patient's cash, checks, or credit cards for any purpose
• Shop with a patient's money (even if asked to)
• Accept money "for gas" or "for trouble"
• Manage a patient's finances in any capacity

If a patient needs assistance with grocery shopping or errands, the process for handling funds is documented in the care plan and must be pre-approved by the supervisor. Any funds handled must be documented with a receipt.

What Billing Integrity Means for You
Your job is simple: show up, do the work, document it accurately, and clock in/out honestly. The billing team handles the rest. If you are ever unsure about a billing question from a patient or family, redirect them to the office. Do not make financial representations on behalf of the agency.

Real-World Scenario

Tom is a caregiver who drives 30 minutes to reach his patient's home. To compensate for travel time, he gets into the habit of clocking in as soon as he leaves his house. Some weeks, this adds 2–3 hours of billed time that was not spent in the patient's home.

The problem:

• Noble Care is billing the patient for time when Tom was not providing services.
• This is billing fraud — even if Tom does excellent care during the actual visit.
• If discovered in an audit, Noble Care faces repayment obligations and potential False Claims Act liability.
• Tom faces immediate termination and potential personal legal liability.

The solution: Clock in when you arrive at the patient's home. If travel time is excessive, speak to your supervisor about scheduling adjustments — there may be solutions. But manipulating clock times is never acceptable.