The Medicare Compliance Toolkit

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Publication Details

  • Publication Date: 2013
  • Pub Code: BCMCTK-11WEB
  • Pages: 52
  • PDF version: 1,052 KB
  • ISBN: 978-1-936230-50-1

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The Medicare Compliance Toolkit

A wide-ranging set of “how-to” compliance tools covering everything from coding, billing, documentation and reimbursement to Recovery Audit Contractors and OIG audits. This handy resource is packed with more than 40 sample forms, policies, procedures, decision trees and other practical tools you can quickly adapt to fit your organization’s compliance program.

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From the editors of Report on Medicare Compliance

With more than 40 sample forms, policies, procedures, decision trees and other practical tools you can adapt to your compliance program, The Medicare Compliance Toolkit is a must-have resource that will help you run a more effective compliance operation.

This report from the editors of Report on Medicare Compliance contains a wide-ranging set of “how-to” tools, covering everything from coding, billing, documentation and reimbursement to Recovery Audit Contractors and OIG audits.

The Medicare Compliance Toolkit is packed with field-tested tools — from top hospitals, health systems and consulting firms across the nation — including:

  • Tailored checklists for documenting and clarifying physicians’ findings on hot-button diagnoses such as malnutrition and major joint replacement.
  • Sample attestation forms and management logs to manage and mitigate conflicts of interest.
  • Guidance on complying with the Stark law, including a flow chart to determine which financial relationships the law applies to, an algorithm for calculating fair market value and sample leases.
  • Recommended elements of a hospital discharge summary.
  • An intake form for hospitals to use in reviewing proposed contracts with physicians and vendors.
  • A social media policy template.
  • Methods to assess compliance-program effectiveness.

Order The Medicare Compliance Toolkit today and ensure that you’re prepared to monitor, evaluate and address your organization’s top compliance risks!

Table of Contents

General Compliance Program Tools

  • Job Description for Director of Compliance Risk Analytics
  • Template for Social Media Policy
  • Making Sure Employees Have the ‘Right Stuff’
  • Project Assessment: Using the OIG 2012 Work Plan to Identify Risk Areas
  • Evaluating the Effectiveness of Your Compliance Program
  • Preparation Checklist for OCR’s HIPAA Audits
  • Presbyterian Code of Conduct
  • Basic Rules for Witness Interviews
  • Compliance Checklist for Records Management
  • Monitoring Compliance With Charity Care Policies
  • Onboarding Tool: Bringing New Facilities Into Your Compliance Program
  • Screening for Exclusion: Ensuring That Critical Checks Are Completed

Tools for Executives and Board Members

  • Methods to Assess a Compliance Program
  • Reporting Compliance Measures to Executives, Board Members
  • Rewarding Hospital Executives for Compliance Achievements
  • Dashboard: Reporting RAC Benchmarks to the Board

Tools for Conflicts of Interest

  • Example of Baylor Management Plan for Potential Conflicts of Interest
  • Compliance Program Best Practices: Vendor Relationships
  • Conflict-of-Interest Attestation

Audit Tools

  • Pre-Bill Claim Audit Process Helps Prevent Denials
  • Real-Time Audits Help Catch Errors Faster
  • Grid for Reviewing Inpatient Rehab Facility Compliance
  • Tracking Sheet: Documenting Developments With External Reviews

Physician Tools

  • Intake Form for Reviewing Contracts
  • Worksheet for Auditing Compliance With Incident-to Rules
  • Compliance Quiz for Physician Practices
  • Administrative Time Log for Physicians
  • Gathering Documents for a Stark Review
  • Adapting to the New Medicare Enrollment Change Schedule
  • Applying the Stark Law to Your Arrangements
  • Sample Part-time Lease: Terms and Cheat Sheet
  • Report Cards Make Data Meaningful for Physicians
  • Using Data in Your Program: An Electrophysiology Physician Coding Analysis
  • Fair Market Value Algorithm

Billing, Coding and Documentation Tools

  • Elements of a Discharge Summary
  • Discharge Process Improvement Dashboard
  • Medical-Necessity Documentation Worksheet for Joint Replacement
  • Keeping Score: Calculating Facility Fees at a Wound Care Clinic
  • Developing a Compliant Malnutrition Query
  • Monitoring Medicare Losses for Lab Tests
  • Documentation Template for Major Joint Replacement
  • Infusion Billing Fundamentals

Written By

This book was written by the editorial staff of AIS.

Written For

  • Hospitals and health systems
  • Group practices
  • Health plans
  • Other facilities

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The Medicare Compliance Toolkit

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