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.
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
- Revamping Queries to Get Ready for ICD-10
- 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
- Using an ALJ Checklist to Improve Appeals
- Review Sheet for Deciding Whether to Appeal Medical Necessity Denials
- Writing an Effective Medical Necessity Appeal Letter
- Exclusion Monitoring Checklist
- Job Description for Director of Compliance Risk Analytics
- Making Sure Employees Have the ‘Right Stuff’
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
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 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
- 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
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
This book was written by the editorial staff of AIS.
- Hospitals and health systems
- Group practices
- Health plans
- Other facilities
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The Medicare Compliance Toolkit