Tools
CMS-approved RAC audit issues
We’ve gathered the latest RAC information on the CMS-approved RAC issues in your state and put it together for you in four regional charts we hope you’ll find helpful. Check back regularly; we’ll update the charts every time a RAC posts a new issue so you can always stay on top of the issues RACs may audit in your state, and others in your region.
Editor’s note: These lists are updated on a weekly basis but do not necessarily represent the up-to-date and accurate list from each individual Region list.
Click here to view an updated chart of CMS-approved RAC issues in Region A.
(Updated May 7, 2012)
Click here to view an updated chart of CMS-approved RAC issues in Region B.
(Updated May 7, 2012)
Click here to view an updated chart of CMS-approved RAC issues in Region C.
(Updated April 19, 2012)
Click here to view an updated chart of CMS-approved RAC issues in Region D.
(Updated March 22, 2012)
Free monthly tools
We know that no one likes to reinvent the wheel. So we hope you find our sample forms and other tools helpful for your healthcare organization. We will post one tried and true tool for you to use each month, so check back regularly!
March 2012 –Level of care pocket card
Download this pocket card to use as a helpful tool that provides important “points to remember” when it comes to outpatient surgery as well as information on the appropriate use of observation services.
Click here to download the pocket card.
Editor’s note: Access the free tool by clicking here. This tool was submitted by Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.
Download this pocket card to use as a helpful tool that provides important “points to remember” when it comes to outpatient surgery as well as information on the appropriate use of observation services.
Click here to download the pocket card.
Editor’s note: Access the free tool by clicking here. This tool was submitted by Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.
February 2012 –Sample observation hour form
Download this form to use as a helpful tool that will assist in calculating observation hours at your facility.
Click here to download the form.
Editor’s note: Access the free tool by clicking here. This tool was submitted by Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.
January 2012 – 2012 Recovery Auditor preparedness checklist
Download this checklist to use as a helpful resource for actively planning and protecting against audits and identifying potential risk areas at your facility.
Click here to download the policy.
Editor’s note: Access the free tool by clicking here. This checklist was submitted by Amanda Berglund, MS, MBA, COO, and Elizabeth Lamkin, MHA, CEO, Pace Healthcare Consulting, LLC , in Hilton Head, SC.
December 2011 – Sample risk control assessment questionnaire
Download this sample form to determine whether your facility has controls in place to address risk areas contained in the OIG work plan that may apply to your department.
Click here to download the policy.
Editor’s note: This sample policy was submitted by Stephen A. Miller, JD, Chief Compliance and Privacy Officer for Capital Health System, Inc., in Trenton, NJ.
November 2011 – Sample risk and control inventory
Download this sample form for a convenient way to track multiple forms of risk across different hospital departments.
Click here to download the policy.
Editor’s note: This sample policy was submitted by Stephen A. Miller, JD, Chief Compliance and Privacy Officer for Capital Health System, Inc., in Trenton, NJ.
October 2011 – Charging for supplies sample policy
Download this sample policy source to help determine whether certain items are routine supplies and whether they are separately billable or not.
Click here to download the policy.
Editor’s note: This sample policy was submitted by Denise Williams, RN, CPC-H, Vice President of Revenue Integrity Services for Health Revenue Assurance Associates, Inc., Plantation, FL.
September 2011 – ICD-10-PCS crossword puzzle
Download this fun ICD-10-PCS crossword puzzle to give your coders a unique way of learning the ICD-10 root operations ahead of the 2013 ICD-10 implementation.
Click here to download the tool.
Editor’s note: This crossword puzzle originally appeared in the September version of HCPro’s Medical Records Briefing newsletter.
August 2011 – Important message from Medicare flow diagram
Download this sample flow to assist staff with the delivery and appeal process of the important message from Medicare.
Click here to download the tool.
Editor’s note: This chart was submitted by Christy Whetsell, BSN, RN, MBA, ACM, director of care management at WVU Healthcare in Morgantown, WV.
July 2011 – ACM audit tool for admission review
Download this audit tool for use when an admissions care manager feels there are issues with the admission and decides to consult with the admitting physician.
Click here to download the tool.
Editor’s note: This tool was featured in the new HCPro book, “ The RAC Toolkit for Hospitals and Health Systems,” by Amanda W. Berglund, MS, MBA; Elizabeth E. Lamkin, MHA. Visit HCMarketplace.com for more information or to purchase a copy.
June 2011 – Sample agenda for RAC committee meeting
Download this sample agenda for RAC committee meetings at your facility to ensure oversight and accountability of the team when it comes to RAC and billing compliance.
Click here to download the agenda.
Editor’s note: This tool was featured in the new HCPro book, “ The RAC Toolkit for Hospitals and Health Systems,” by Amanda W. Berglund, MS, MBA; Elizabeth E. Lamkin, MHA. Visit HCMarketplace.com for more information or to purchase a copy.
May 2011 – Revenue integrity project template
Download this sample revenue integrity project template to see an example of a form that can be used to document projects at your facility.
Click here to download the form in PDF format.
Click here to download the form in Excel format.
Editor’s note: This chart was submitted by Donna Wilson, RHIA, CCS, CCDS, senior director at Compliance Concepts in Wexford, PA.
April 2011 – Initial order set example
Download this initial order set form to see an example of an easy-to-use “ticket to the hospital.”
Click here to download the form.
Editor’s note: This chart was submitted by Donna Wilson, RHIA, CCS, CCDS, senior director at Compliance Concepts in Wexford, PA.
March 2011 – Quick reference transfer tool
Download this tool for a quick reference chart for different circumstances of when a discharge is treated as a transfer for payment purposes.
Click here to download the chart.
Editor’s note: This chart was submitted by Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc.
February 2011 – Medicare appeals process summary table
Download this tool to compare the different levels of Medicare appeals, including decision makers, timeframes and results.
Click here to download the chart.
Editor’s note: This chart was submitted by Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc.
January 2011 – Physician supervision summary table
Download this tool to compare 2010 and 2011 requirements for physician supervision of outpatient therapeutic services.
Click here to download the chart.
Editor’s note: This chart was submitted by Kimberly Anderwood Hoy, JD, CPC Director of Medicare and compliance for HCPro, Inc.
December 2010 – UR Physician Review Form
Download this tool to help with your facility’s medical necessity determinations.
Click here to download the list
Editor’s note: This checklist was submitted by Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.
November 2010 – External review audit dashboard
Download this chart to monitor your facility’s external review activity in a way that minimizes confusion and allows you to track potential trends.
Click here to download the chart.
Editor’s note: This chart and accompanying article originally appeared in the November2010 edition of HCPro’s Medical Records Briefing.
October 2010 – Checklist to follow for using condition code 44
Download this checklist to see the verify a set of criteria before billing an outpatient claim with condition code 44.
Click here to download the list
Editor’s note: This checklist was submitted by Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, OK.
September 2010 – Checklist to follow after receiving a demand for repayment letter
Download this checklist and see the steps to take after a demand for repayment letter is received to determine whether or not a particular case has grounds for appeal.
Click here to download the list
Editor’s note: This checklist was submitted by Karen Sagen, Managed Care Leader at Bellin Health Systems, Green Bay, WI.
August 2010 – Six steps for developing a CDI program
Download this list of six steps to follow when developing and implementing a quality clinical documentation improvement program in your facility.
Click here to download the list
Editor’s note: This list originally appeared in the HCPro, Inc. “Coder Productivity: Tapping Your Team’s Talents to Improve Quality and Reduce Accounts Receivable”by Rose Dunn, MBA, CPA, FACHE, FHFMA. Reprinted with permission in the HCPro, Inc“HIM Director’s Handbook, Second Ed.,” by Jean S. Clark, RHIA, CSHA
July 2010 – Ten HIM director questions for ICD-10 implementation
Download this checklist of ten questions that every HIM director should consider concerning ICD-10-CM to help formulate an action plan well ahead of its implementation.
Click here to download the list
Editor’s note: This chart originally appeared in the HCPro, Inc“HIM Director’s Handbook, Second Ed.,” by Jean S. Clark, RHIA, CSHA.
June 2010 – List of “Once in a lifetime” procedures
Download this list of once in a lifetime procedures that will help to acknowledge potential coding and billing errors that a medically unlikely edit may not catch.
Click here to download the list
Editor’s note: This questionnaire was submitted by a provider on the “Audit Talk” list serv.
May 2010 – Sample provider intake questionnaire for MIC audits
Download this MIC provider intake questionnaire (actual document sent from the MIC) to get an early look at the form providers need to fill out that requires an audited hospital to list all previous recoupments and identify its board members and billing services.
Click here to download the template
Editor’s note: This questionnaire was submitted by a provider whom received it directly from a MIC contractor.
April 2010 – RAC Request For Reconsideration Template
Download this template, which was created for a recent automated RAC audit for a physician practice, as a handy tool to use for potential requests for redeterminations from RACs in the future.
Click here to download the template
Editor’s note: This template was submitted by a provider that coordinated this appeal for a community hospital in Washington.
March 2010 – Physician Supervision Requirements Table
Download this table to get a useful resource for determining physician supervision requirements for hospital outpatient therapeutic services.
Click here to download the physician supervision table
Editor’s note: This tool originally appeared in the HCPro, Inc book, “The RAC Survival Guide.”
February 2010 – Dealing with Government Auditors Chart and Article
Download this chart to get a detailed look at dealing with different government auditors, such as RACs, MICs, MACs, ZPICs, and others, as well as an accompanying article explaining the helpful ways to use the chart.
Click here to download the auditor chart
Editor’s note: This tool originally appeared in February 2010 issue of, “Medical Records Briefing.”
January 2010 – RAC Medical Record Compilation and Appeal Flow Charts
Download these flow charts to get a detailed look at the timeline for handling medical record requests and appeals.
Click here to download the flow chart
Editor’s note: This tool originally appeared in the HCPro, Inc book, “The RAC Survival Guide.”
December 2009 – PFS Sample Job Competencies
Move your patient financial services (PFS) department to the next level by making your staff more successful. Measure staff members’ competencies with this free tool.
Click here to download the sample job competencies.
Editor’s note: This tool originally appeared in the HCPro, Inc “PFS Director’s Handbook.”
November 2009 – New ICD-9-CM codes
Download this chart of the new ICD-9 codes, including E and V codes, to make sure you’re on top of the code changes for 2010.
Click here to download the chart of new ICD-9 codes.
Editor’s note: This chart originally appeared in the October issue of Medical Records Briefing.
October 2009 – Incident to Audit Checklist
Download this checklist to help ensure you’re compliant with Medicare incident to requirements.
Click here to download the Incident to Checklist.
Editor’s note: Thanks to Elin Baklid-Kunz, MBA, CPC, CCS, the director of physician services for Halifax Health in Daytona Beach, FL, and JustCoding.com for providing this helpful tool.
September 2009 – Sample RAC Appeal Letter Outline
The RAC permanent program has begun, and you may soon need to begin appealing denials. Make sure your appeal letters include all of the necessary information by checking against our sample appeal letter outline. We hope you find it useful as you combat RAC denials.
Click here to download the RAC Appeal Letter Outline.
Editor’s note: Thanks to Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City, for providing this helpful tool.
August 2009 – Sample RAC Tracking Spreadsheet
Have you developed a way to manage the complex task of tracking your RAC requests and appeals? If not, consider using this tracking spreadsheet as a guide.
Click here to download the RAC Tracking Spreadsheet.
Editor’s note: This form is courtesy of Tanja Twist, MBA/HCM, who spoke on the July 21 HCPro audio conference, “Medicare Appeals: Overturn RAC Denials Using the Medicare Appeal Process.”
July 2009 – Sample Template for Initial Preventive Physical Examination
Take advantage of this handy tool to ensure that your physicians don’t overlook Initial Preventative Physicial Examination (IPPE) requirements.
Click here to download the IPPE template.
Editor’s note: This form is courtesy of JustCoding.com and Lori-Lynne Webb, CPC, CCS-P, CCP, an independent coding consultant in Melba, ID.
June 2009 – Sample ABN Audit Preparation Tool
Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with this auditing checklist.
Click here to download the sample ABN Audit Preparation tool.
Editor’s note: This sample tool is excerpted from the Medical Necessity Training Toolkit, published by HCPro, Inc.
May 2009 – Sample Chargemaster Review List
There are myriad ways to review a hospital’s chargemaster or the chargemasters for a system of hospitals. Use the following list to help guide you in your approach to a chargemaster review.
Click here to download the Chargemaster Review List.
Editor’s note: This Chargemaster Review List is excerpted from The Chargemaster Coordinator’s Handbook, published by HCPro, Inc.
April 2009 – Sample Injections and Infusions Handout
Ensuring accurate capture of injection and infusion administration and drug codes is an important part of ensuring your facility receives the reimbursement it deserves. Consider this sample injection and infusion handout to help with injection and infusion billing and coding accuracy.
Click here to download the sample injections and infusions handout.
Editor’s note: This handout is reprinted courtesy of Sharon Clayton, RN, MS, MBA, CPC, president of Key Healthcare Consulting, LLC.
March 2009 – Sample Patient Access Daily and Montly QA Chart
Click here to download the sample patient access daily QA.
Click here to download the sample patient access monthly QA.
Take advantage of these sample checklists as you perform daily and monthly quality assurance checks on your patient access staff members.
Editor’s note: The sample analysis chart is excerpted from the Revenue Cycle Management Toolkit: A Comprehensive Guide to Managing Cash Flow, published by HCPro, Inc.
February 2009 – Sample Denial Analysis Totals by Month Chart
If your facility doesn’t have enough staff members to work all of your denials, tracking them will allow you to make appropriate judgements as to how you will allocate the staffing resources you do have. Consider using this sample chart as a guide as you set up your own tracking system.
Click here to download the sample Denial Analysis Totals by Month chart.
Editor’s note: The sample analysis chart is excerpted from The PFS Director’s Handbook, by Steven Gary Orvis, MPH, and published by HCPro, Inc.
January 2009 – Sample Draft RAC Appeal Letter
You have limited time to respond to a RAC demand letter and to provide the medical records necessary to appeal any denials. Consider this sample letter to help ensure your response is thorough and effective.
Click here to download the draft RAC appeal letter.
Editor’s note: The sample letter is reprinted courtesy of Tanja Twist, MBA/HCM, director of patient financial services for Methodist Hospital in Arcadia, CA, and The HIM Director’s Guide to Recovery Audit Contractors published by HCPro, Inc.
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