Master List of Risk Areas and Compliance Tools

Alphabetical Listing of Risk Areas

Front-End Processes

• Advance Beneficiary Notices/Hospital-Issued Notice of Non-Coverage
  • Policies and Procedures
  • Compliance Checklist
• Certification and Recertification
  • Policies and Procedures
  • Compliance Checklist
• Inpatient-Only Procedures
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheets:
    • Monitor Assignment of Modifier -CA When an Outpatient Dies
• Medicare Secondary Payer
  • Policies and Procedures
  • Compliance Checklist
• Observation or Admission
  • Policies and Procedures
  • Compliance Checklist
  • Observation Documentation Checklist

Central Processes

• Common Coding Errors (including Upcoding and Unbundling)
  • Policies and Procedures
  • Compliance Checklist
• Length of Stay Issues
  • Policies and Procedures
  • Compliance Checklist
• Transfers and Discharges
  • Policies and Procedures
  • Compliance Checklist
• Medical Necessity
  • Policies and Procedures
  • Compliance Checklist
• Documentation
  • Policies and Procedures
  • Compliance Checklist
• Hospital-Acquired Conditions/Present-on-Admission Reporting
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheet
• Records Management
  • Policies and Procedures
  • Compliance Checklist
• False Claims Exposure
  • Policies and Procedures
  • Compliance Checklist
• Copayments and Deductibles (under development)

Back-End Processes

• Bad Debt
  • Policies and Procedures
  • Compliance Checklist
• Medicare Cost Reports
  • Policies and Procedures
  • Compliance Checklist
• Outlier Payments
  • Policies and Procedures
  • Compliance Checklist
• Overpayments and Credit Balances
  • Policies and Procedures
  • Compliance Checklist

Special High-Risk Areas

• Billing for Hospital Inpatient Services
  • Policies and Procedures
  • Compliance Checklist
  • The Three-Day Payment Window (72-Hour Rule)
    • Policies and Procedures
    • Compliance Checklist
• Billing for Hospital Outpatient Services
  • Policies and Procedures
  • Compliance Checklist
• Clinical Trials Reimbursement
  • Policies and Procedures
  • Compliance Checklist
• Inpatient Rehabilitation Facilities (under development)
• Long-Term Care Hospitals (under development)
• Critical Access Hospitals (CAH)
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheet
• Outpatient Rehabilitation Facilities
  • Policies and Procedures
  • Compliance Checklist
• Laboratories (under development)
• Medical Devices (under development)
• Drugs, Biologicals and Radiopharmaceuticals
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheet to Monitor Billing for Blood and Blood Products

Compliance Profiles

• Corporate Compliance and Billing
  • Policy Decision-Making Checklist
  • OIG Program Compliance Checklist
• Preparing for an Audit
  • CMS Manuals
• Conducting the Audit: Auditing Tools and Techniques
  • Sample Data Table
• Government Enforcement and Initiatives

Alphabetical Listing of Risk Areas

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

Bad Debt

Billing for Hospital Inpatient Services

Billing for Hospital Outpatient Services

Certification and Recertification

Clinical Trials Reimbursement

Common Coding Errors (including Upcoding and Unbundling)

Copayments and Deductibles (under development)

Critical Access Hospitals (CAH)

Documentation

Drugs, Biologicals and Radiopharmaceuticals

False Claims Exposure

Hospital-Acquired Conditions/Present-on-Admission Indicators

Inpatient Rehabilitation Facilities (under development)

Inpatient-Only Procedures

Laboratories (under development)

Length of Stay Issues

Long-Term Care Hospitals (under development)

Medical Devices (under development)

Medical Necessity

Medicare Cost Reports

Medicare Secondary Payer

Observation or Admission

Outlier Payments

Outpatient Rehabilitation Facilities

Overpayments and Credit Balances

Records Management

The Three-Day Payment Window (72-Hour Rule)

Transfers and Discharges