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Billing & Coding

Guidelines We Follow

Montefiore Nyack Hospital follows these guidelines to ensure our billing and coding practices are fair, accurate and in compliance with government regulations. 

  • Montefiore Nyack Hospital is committed to full compliance with all rules and regulations of government healthcare programs, including Medicare and Medicaid. Montefiore Nyack Hospital also complies with the rules and requirements of all commercial insurance programs.
  • Montefiore Nyack Hospital bills for eligible services that are rendered, appropriately documented and consistent with the medical necessity guidelines provided by the insurance company.
  • Montefiore Nyack Hospital trains all staff, clinicians, coders and billers on proper coding, charge capture and billing. We also update our Charge Description Master (CDM) and have reliable systems in place to prevent false and inaccurate claims.
  • Employees involved in billing and coding are expected to be knowledgeable in all aspects of current laws and regulations affecting their duties. They must take all reasonable steps to ensure their work is accurate, efficient, supported by the medical record and compliant with applicable laws and regulations.

As part of our commitment to full compliance, we do not:

  • Bill for items and services that are not rendered or not medically necessary.
  • Misrepresent the type or level of service rendered.
  • Bill for non-covered services.
  • Inappropriately unbundle services.
  • Bill for services rendered by other providers.
  • Misrepresent a diagnosis in order to obtain payment.

Billing concerns

If you have knowledge of any billing errors or improprieties, or if you suspect that an individual’s conduct with regard to billing practices is in direct violation with established hospital policies, immediately tell your supervisor. You may also contact the Hospital’s Compliance Officer or call the Compliance Hotline at 888-568-8548. The matter will be promptly investigated and any claims or billing errors found will be corrected.