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 a chart we hope you’ll find helpful. Check back regularly; we’ll update the chart 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.

Click here to view an updated chart of CMS-approved RAC issues.

(Updated November 4, 2009)

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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!

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.

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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.

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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.

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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.”

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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.

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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.

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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.

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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.

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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.

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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.

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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.