Registration

1. Authorization/Release Consent Forms ABN Orders LMRP/NCD Registration MSP Questionnaire 72 hour rule HIPAA Patient Demographic Information Insurance Information Pre-certifications

2. Complete/legible/signatures Proper procedure selection for billing entry system Patient Service Areas Authorization --- Orders Service = Order Documentation = Actual Services Late entries and corrections ABN Support for Medical Necessity LMRP Confidentiality

3. Charge Description Master CDM Accurate CPT Assignment Accurate Revenue Code Assignment Documentation Bundling / Unbundling Understanding HIM coding responsibility

4. Health Information Management Documentation Coding of Diagnoses / Procedures Complications/Co-morbidities Physician Queries

5. Billing Documentation Modifiers CCI Edits 72 Hour Rule Site of Service

6. Collections Refunds Documentation Timeliness Documentation of Credit Balances Credit Balance Reporting Credit Balances Returned Reasonable Efforts to Collect – Medicare Bad Debts

7. Your responsibilities

8. Summary • Compliance is a Team Effort! • Personal protection • Organizational protection • Individuals can be held responsible for issues of fraud and abuse.

9. Lesson 4 Medicare Target Areas - Section 2 Health Care Compliance If you have any questions or concerns regarding this course, please contact Cindy Dupree at cdupree@draffin-tucker.com.