Author Topic: Compliance  (Read 1634 times)

D alane

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Compliance
« on: September 28, 2011, 01:25:31 PM »
I am starting a new part time job which will involve reviewing charts to be sure charts have the necessary forms and documentation necessary for not only HPPA, but for managed care.    Does anyone know if there is a set rule of thumb, or will it vary depending on the insurance company?  I do realize authorizations need to be on file for those who require them- but as far as notes, forms etc.

Thank you

Michele

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Re: Compliance
« Reply #1 on: September 29, 2011, 08:02:59 AM »
If it is for HIPAA policy it won't vary by carrier.  There are not any universal forms that I'm aware of for managed care.  I haven't done any chart reviewing lately, and my experience before was limited, so I can't really say much more.

Anybody else??
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PMRNC

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Re: Compliance
« Reply #2 on: October 01, 2011, 10:57:39 AM »
Other things you will want to look for are financial hardship agreements, Medicare ABN's, pre-certifications, and pre-determinations if you are dealing with surgeon's or high dollar claims. In addition, I always make sure there is a signed office/financial policy in every single chart!!
Linda Walker
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