INSIDE - Health Care Compliance Association
INSIDE - Health Care Compliance Association
INSIDE - Health Care Compliance Association
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ACADEMIC HEALTH CENTERS CFG...continued from page 7<br />
There’s also opportunities to gather<br />
information to monitor HIPAA<br />
effectiveness and risk management<br />
issues<br />
While you are reviewing the medical<br />
records, are there other opportunities to<br />
gather information for other compliance<br />
purposes? Is there a Notice of<br />
Privacy Policy, after April 14, 2003?<br />
How would you note a potential quality<br />
of care or risk management issue?<br />
Track outcomes both as number of<br />
outcomes within the sample, and the<br />
dollar value<br />
Reporting based on dollar values may<br />
either add emphasis or offer an alternative<br />
perspective. Be sure to identify the<br />
reasons for overpayments and underbilling.<br />
There may be several comments<br />
about a specific encounter, but its very<br />
helpful to be able to quickly identify<br />
which ones have the most significant<br />
financial impact.<br />
It’s also important to track based on<br />
specific findings. You may also want to<br />
be able to quickly identify findings that<br />
mirror prior issues or are a current regulatory<br />
focus.<br />
<strong>Compliance</strong> continues to evolve into<br />
ever increasing complexity<br />
Data elements captured will change as<br />
new issues and focus areas arise. Rules<br />
will change, so adding effective dates<br />
may be helpful. Tracking education,<br />
refunding, and follow up testing by<br />
provider can also be a useful tool in<br />
managing your compliance efforts and<br />
measuring effectiveness. ■<br />
Database fields for physician services audits:<br />
Tracking the audit:<br />
Control number assigned to the audit<br />
Name of individual performing the review<br />
Name of individual providing supervision and review<br />
Provider information:<br />
Name of provider<br />
Provider number<br />
Physician, ARNP, or PA?<br />
Division<br />
Department<br />
Medical record:<br />
Name of the patient<br />
Medical record number<br />
Invoice number<br />
Date of service<br />
Type of documentation<br />
The bill:<br />
Was the encounter form signed?<br />
The service:<br />
Rendered by physician alone<br />
Resident involved in service<br />
Teaching physician documentation<br />
Site of service<br />
ARNP/PA involved in service<br />
ARNP/PA performed service alone<br />
Incident to<br />
CPT code(s)<br />
E&M service or procedure?<br />
ICD-9 code(s)<br />
Inpatient/Hospital-based/Outpatient setting<br />
Name of clinic<br />
Payor and payment:<br />
Payor<br />
Amount Charged<br />
Findings:<br />
Compliant or non-compliant?<br />
Corrected CPT code?<br />
Refund required?<br />
Full refund?<br />
Partial refund?<br />
Amount of refund?<br />
Reason for refund?<br />
Underbilled?<br />
Administrative or physician error?<br />
Description of error (additional tables can be added<br />
including extensive descriptors) ■<br />
July 2003<br />
8