A Guide to Auditing Health Care Billing Practices

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Price: $397 Format: Looseleaf guide plus quarterly updates and monthly news summaries ISBN: 0-929156-59-5 Pub Code: AUD

Billing errors have been the basis for most of the multi-million-dollar settlements paid to the U.S. government by hospitals and other health care organizations. But for the majority of health care providers, threat of enormous settlements isn’t the primary daily concern. It’s merely getting that bill right for a particular service, so that you don’t have to deal with overpayments, delayed payments and rejected claims.

A Guide to Auditing Health Care Billing Practices helps you avoid problems in many of the most troublesome areas of Medicare billing — including billing for transfers and discharges, drugs, services at teaching hospitals, critical care, “incident to” services, lab, observation, advanced beneficiary notices (ABNs), Medicare as Secondary Payer (MSP) and more.

With monthly updates and current developments summaries, the Guide provides detailed “how-to” guidance on cleaning up your billing practices before the feds come knocking. It will walk you through the billing, monitoring and auditing steps you need to take to avoid the potentially staggering monetary penalties you may face if errors are not found and fixed. Subscribe today and you’ll be able to scrutinize and tighten each step of your billing process to reduce potentially fraudulent claims.

Table of Contents

• Complexity of the Billing Process
• Coding and Documentation
• From Records to Codes to Claims
• Monitoring and Auditing Your Billing Processes for Compliance
  

• How the Government Identifies Health Care Fraud and Abuse
• Home Health Overbilling
• Billing Liability
  

• Internal vs. External Review
• The Compliance Team
• Audit, Data Analysis and Reporting
• Regulation Interpretation
• Education and Training
• Insurance Claims Processing
• Investigation
• The Importance of Communication
  

• Federal Laws, Regulations and Guidance
• Official Coding Resources
• The Office of the Inspector General
• The Internet as a Resource
  

• Patient Registration and Admission
• Documentation of Patient Care
• Resulting for Tests, Equipment and Supplies
• Diagnostic and Procedural Coding
• The Charge Capture Process: Encounter Forms and Chargemasters
• Processes for Making Edits Manually
• Electronic Data Interface
• Denials
• Collection of Copayments
  

• The HCFA 1500 Form
• Conducting the Information Systems Compliance Audit
• The Flow Diagram
• List of Data Elements
• The System Prototype
• The Audit Plan
• Categorizing Changes Made by the System
• Developing an Action Plan
• The Billing Information Systems Compliance Audit: Other Benefits to the Provider Organization
  

• Laboratory Billing Compliance Issues
• Hospital Billing Compliance Issues
• Drugs, Devices and Biologicals Eligible for Passthrough Payments under OPPS
• Billing for Self-Administered Drugs

• Preparing for the Audit
• Selecting the Audit Sample
• Random Sample Development With RAT-STATS
• Government Models for Audits
• Conducting the Audit
• Analyzing the Data
• Reporting on the Results
• Educating on the Deficiencies
• Post-Audit Follow-Up
• The Audit Flow Chart
  

• The Components
• Policies and Procedures
• Assessing Risk
• Compliance Education
• Continuous Monitoring and Auditing
• Addressing Noncompliance
• Operating Under a Corporate Integrity Agreement
• Preserving Compliance Information
  

• Evaluating and Strengthening Your Internal Controls
• Hospitals in Jam Over Medical Necessity for Lab Tests; Two Solutions Available
• Perform Intensive Chart Reviews to Improve Physician Billing Compliance
• Use Free HCFA Data To Benchmark Billing for Underpayments, Overpayments
• Feds' Probe of Hospital Drug Billing Narrows to Take-Home Meds; Use Code 253
• Codification Is a Shortcut for Tracking Billing Compliance; Can Be Done Affordably
• What to Do with What Your Data Tells You
• Look for Manipulations in DRG Clusters; Use Stratified Samples in Your Reviews

• Health Care Fraud and Abuse: Legal Structure, Enforcement Strategies, and Agency Programs
• Privacy of Patient Information under HIPAA
• CMS/OIG Enforcement Initiatives

 

Written By

A Guide to Auditing Health Care Billing Practices is written by the staff of Atlantic Information Services, Inc.

 

Written For

• Billing Directors
• Medical Records and HIM Managers
• Coding Managers
• Patient Accounting Directors
• Internal Auditors
• Compliance Auditors
• IS Directors
• CFOs and Finance Managers
• CPAs, Attorneys and Consultants

 

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63 Billing and Coding Strategies for Medicare Compliance
A Guide to Auditing and Monitoring HIPAA Privacy Compliance