Master List of Risk Areas and Compliance Tools

Alphabetical Listing of Risk Areas

Front-End Processes

• Advance Beneficiary Notices
  • 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
  • Policies and Procedures
  • Compliance Checklist
• ‘Never’ Events
• Policies and Procedures
• Compliance Checklist

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 OPPS Hospital Outpatient Services
  • Policies and Procedures
  • Compliance Checklist
  • Physician Supervision of Outpatient Diagnostic and Therapeutic Services
    • Policies and Procedures
    • Compliance Checklist
• Clinical Trials Reimbursement
  • Policies and Procedures
  • Compliance Checklist
• Long-Term Care Hospitals
  • Policies and Procedures
  • Compliance Checklist
• Critical Access Hospitals (CAH)
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheet
• Outpatient Rehabilitation Facilities
  • Policies and Procedures
  • Compliance Checklist
• Laboratories
  • Policies and Procedures
  • Compliance Checklist
• Implantable Medical Devices
  • Policies and Procedures
  • Compliance Checklist
• Drugs, Biologicals and Radiopharmaceuticals
  • Policies and Procedures
  • Compliance Checklist
  • Compliance Worksheet to Monitor Billing for Blood and Blood Products
• Diagnostic X-Rays in the Emergency Room
• Policies and Procedures
• Compliance Checklist

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

Bad Debt

Billing for Hospital Inpatient Services

Billing for OPPS Hospital Outpatient Services

Certification and Recertification

Clinical Trials Reimbursement

Common Coding Errors (including Upcoding and Unbundling)

Copayments and Deductibles

Critical Access Hospitals (CAH)

Diagnostic X-Rays in the Emergency Room

Documentation

Drugs, Biologicals and Radiopharmaceuticals

False Claims Exposure

Hospital-Acquired Conditions/Present-on-Admission Indicators

Inpatient-Only Procedures

Laboratories

Length of Stay Issues

Long-Term Care Hospitals

Implantable Medical Devices

Medical Necessity

Medicare Cost Reports

Medicare Secondary Payer

‘Never’ Events

Observation or Admission

Outlier Payments

Outpatient Rehabilitation Facilities

Overpayments and Credit Balances

Physician Supervision of Outpatient Diagnostic and Therapeutic Services

Records Management

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

Transfers and Discharges