Master List of Best Practices

Front-End Processes

• Advance Beneficiary Notices/Hospital-Issued Notice of Non-Coverage

• Certification and Recertification

• Inpatient-only Procedures

• Medicare Secondary Payer

• Observation or Admission

Central Processes

• Common Coding Errors (including Upcoding and Unbundling)

• Length of Stay Issues

• Transfers and Discharges

• Medical Necessity

• Documentation

• Hospital-Acquired Conditions/Present-on-Admission Reporting

• Records Management

• False Claims Exposure

• Copayments and Deductibles
• 'Never' Events

Back-End Processes

• Bad Debt

• Medicare Cost Reports

• Outlier Payments

• Overpayments and Credit Balances

Special High-Risk Areas

• Billing for Hospital Inpatient Services
  • The Three-Day Payment Window (72-Hour Rule)

• Billing for OPPS Hospital Outpatient Services
  • Physician Supervision of Outpatient Diagnostic and Therapeutic Services

• Clinical Trials Reimbursement

• Long-Term Care Hospitals
• Critical Access Hospitals (CAH)
• Outpatient Rehabilitation Facilities
• Laboratories
• Implantable Medical Devices
• Drugs, Biologicals and Radiopharmaceuticals
• Diagnostic X-Rays in the Emergency Room

Compliance Profiles

• The Billing Compliance Environment
• Preparing for an Audit
• Conducting the Audit: Auditing Tools and Techniques
• Government Enforcement and Initiatives