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New Jersey Occupational Therapy Billing and Fees
Unprofessional Billing Conduct
No licensee shall submit any claim, bill or governmental assistance claim to a third-party payor for occupational therapy services rendered to any client that involves dishonesty, fraud, deception or misrepresentation.
No licensee shall submit to a third-party payor any claim, bill or governmental assistance claim, which contains any of the following:
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.
The accuracy of all information contained in written or electronic submissions to a third-party payor, 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.
All insurance records shall be maintained pursuant to the provisions of N.J.A.C. 13:44K-10.
Financial Arrangements with Clients and Third-Party Payors
Fees for occupational therapy services shall be reasonable and commensurate with the status and experience of the occupational therapist offering like services or treatment in the geographic area and shall be consistent with the provisions prohibiting excessive fees.
Prior to the initiation of occupational therapy services, the occupational therapist or his or her designee shall explain to the client in an understandable manner the financial arrangements for the services that will be provided. The information provided to the client shall include the following:
An occupational therapist shall not require a client or a third party payor to pay:
An occupational therapist shall prepare and maintain a written list of current fees for standard services and, upon request, shall provide the list to clients. The list shall include the following information:
An occupational therapist shall provide a copy of a written fee schedule to any interested person upon request.
An occupational therapist shall not charge an excessive fee for services. Factors which the Council may consider in determining whether a fee is excessive include the following:
N.J.A.C. § 13:44K-8.9
N.J.A.C. § 13:44K-9.2
N.J.A.C. § 13:44K-9.4