A
Guide to Auditing
Health Care Billing Practices |
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 isnt the primary daily concern. Its merely
getting that bill right for a particular service, so that you dont
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 youll be able to scrutinize and
tighten each step of your billing process to reduce potentially fraudulent
claims.
Table
of Contents
Chapter One: Overview of the Billing
Process
-
Complexity of the
Billing Process
-
Coding and Documentation
-
From Records to Codes
to Claims
-
Monitoring and Auditing
Your Billing Processes for Compliance
Chapter Two: Recognizing
Problematic Billing Practices
-
How the Government Identifies Health Care Fraud and Abuse
-
Home Health Overbilling
-
Billing Liability
Chapter Three: Selecting the Audit Team
-
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
Chapter Four: Resources Available to Shape Your Billing
Audit
-
Federal Laws, Regulations and Guidance
-
Official Coding Resources
-
The Office of the Inspector General
-
The Internet as a Resource
Chapter Five: Auditing the Components of your Billing
Process
-
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
Chapter Six: Auditing the Components of Your IS Billing
Systems
-
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
Chapter Seven: Dealing With Special Billing Compliance
Problems
-
Laboratory Billing Compliance Issues
-
Hospital Billing Compliance Issues
-
Drugs, Devices and Biologicals Eligible for Passthrough
Payments under OPPS
-
Billing for Self-Administered Drugs
Chapter Eight: Developing and Analyzing Your Billing
Data
-
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
Chapter Nine: Maintaining Your Billing Process Audit
-
The Components
-
Policies and Procedures
-
Assessing Risk
-
Compliance Education
-
Continuous Monitoring and Auditing
-
Addressing Noncompliance
-
Operating Under a Corporate Integrity Agreement
-
Preserving Compliance Information
Chapter Ten: Other Audit Tools and Techniques
-
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
Chapter Eleven: Other Billing Issues/Government Enforcement
Initiatives
-
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
AIS
Guarantee
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Health Care Billing Practices for a 30-day risk-free inspection
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it to AIS and we will send you a prompt, full refund or credit.
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Related
Publications
Report
on Medicare Compliance
HIPAA Patient Privacy Compliance Guide
63 Billing and Coding Strategies for Medicare
Compliance
A Guide to Auditing and Monitoring HIPAA Privacy
Compliance