The Medicare Compliance Toolkit

View Sample (PDF)

Highlights on this Page

Publication Details

  • Publication Date: 2016
  • Pub Code: BCMCTK4-11WEB
  • Pages: 66
  • PDF version: 2,615 KB
  • ISBN: 978-1-939721-20-4

3 Easy Ways to Order

  1. Secure Shopping Cart
  2. Call 800-521-4323
  3. Print a form to fax or mail

The Medicare Compliance Toolkit

A wide-ranging set of “how-to” compliance tools covering everything from coding, billing, documentation and reimbursement to Administrative Law Judge appeals 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.

Place your order through our secure shopping cart


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 Administrative Law Judge appeals 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:

  • Checklists designed to speed appeals through the process,
  • Questions to consider when investing in electronic medical records,
  • Review sheets for deciding whether to appeal medical necessity denials,
  • Conflict-of-interest policies related to drug samples,
  • Audit checklists for provider-based entities, and
  • Discharge summaries to substantiate the use of specific diagnosis codes.

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

  • Decision Tree for Using Outside Counsel/Consultants vs. Handling Compliance Matters Internally
  • Engaging Employees in the Compliance Program
  • Questions to Consider When Investing in EMRs
  • Raising Employee Awareness About Cybersecurity
  • Information Risk Management Questionnaire for Vendors
  • Employee Quiz: Taking the Temperature of Compliance Culture
  • Review Sheet for Deciding Whether to Appeal Medical Necessity Denials
  • Writing an Effective Medical Necessity Appeal Letter
  • Making Sure Employees Have the ‘Right Stuff’
  • Patient Notice: How One Hospital Explains to Patients Their Personal Health Record Option
  • Mobile Device Use Agreement for Employees
  • Keeping Tabs on Requirements for Signs, Notices
  • Compliance Dashboard for First Quarter 2015
  • Policy on Use of Social Media
  • Compliance Checklist for Telehealth

Tools for Executives and Board Members

  • Reporting High-Level RAC Findings to Leadership
  • Methods to Assess a Compliance Program
  • Reporting Compliance Measures to Executives, Board Members
  • Rewarding Hospital Executives for Compliance Achievements
  • Auditing and Monitoring Your Compliance Program: One Example
  • Checklist for the Nexus of Quality and Compliance
  • Sample Questions for Exit Interviews

Tools for Conflicts of Interest

  • Policy on Drug Samples
  • Example of Baylor Management Plan for Potential Conflicts of Interest
  • Compliance Program Best Practices: Vendor Relationships

Audit Tools

  • Audit Checklist for Provider-Based Entities
  • Spreadsheet for Malnutrition/Kwashiorkor Audits
  • Pre-Bill Claim Audit Process Helps Prevent Denials
  • Grid for Reviewing Inpatient Rehab Facility Compliance

Physician Tools

  • Physician Checklist for Implanting ICDs
  • Dignity Health Procedure on ICDs
  • Obtaining Complete Information From Physicians Before Surgery
  • Monitoring Internal Data — External Audit Results
  • Will Work for Food: Service Agreements Under Stark
  • Hospital Policy for Protocols
  • Intake Form for Reviewing Contracts
  • Worksheet for Auditing Compliance With Incident-to Rules
  • Administrative Time Log for Physicians
  • Gathering Documents for a Stark Review
  • Adapting to the New Medicare Enrollment Change Schedule
  • Assessing Whether Deals Are Commercially Reasonable Under Stark

Billing, Coding and Documentation Tools

  • Mining Data for Compliance With Billing for New vs. Established Visits
  • Discharge Summary That Substantiates the Use of Diagnosis Code 260
  • Ensuring Medical-Necessity Compliance for Popular Infusion Drugs
  • Improving the Patient Discharge Planning Process
  • Elements of a Discharge Summary
  • Discharge Process Improvement Dashboard
  • Medical-Necessity Documentation Worksheet for Joint Replacement
  • Documentation Template for Major Joint Replacement
  • Monitoring Compliance With Billing Rules for Same-Day Surgery

Written By

This book was written by the editorial staff of AIS.

Written For

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

Shipping Information

Print Version:
This item is shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes.) You should receive your order within 5-7 business days. Shipping and handling cost is $12 per item.

PDF Version:
Immediately after submitting your order through our secure shopping cart, you will receive an email with a link directing you to download the PDF file of the book. If you place your order via phone, fax or mail, the PDF version will be emailed to you when your order is processed (usually within 1 business day). Shipping costs will not be charged for this item.

Rush orders:
Please call us at 800-521-4323 to place a rush order. We will overnight your order for an additional charge of $45, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

View Sample (PDF)

The Medicare Compliance Toolkit

Place your order through our secure shopping cart


Renewal Center

Renew your subscriptions to AIS newsletters and looseleaf publications at the Renewal Center