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P-R-E-P-A-R-E: Policies and Procedures Cheat Sheet (DRAFT) by [deleted]

Policies and Procedures

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Policies and Procedures

Every healthcare organi­zation must develop facility specific protocols that define the rules of engagement for the operations to detect, deter and mitigate fraudulent activity. In addition, these Policies and Procedures are dynamic, refined and current with the changing landscape related to regula­tory, reimbu­rsement and techno­logical changes. For example, the innovation of cell phones with readily accessible camera functi­onality spurred a wave of HIPAA violations across the nation. Skilled Nursing Facilities immedi­ately responded with additional policies on the parameters for employee, resident and visitor cell phone usage. This situation exempl­ifies the importance of the dynamic, refined and current policies and proced­ures.

Start of a Table of Contents

Arrang­ements with Health Care Providers Involving Patient Referrals
Benefi­ciary Induce­ments
Health Care Profes­sional Creden­tialing
Privacy and Security of Protected Health Inform­ation
Record Keeping and Docume­ntation
Refund of Overpa­yments
Responding to Government Invest­iga­tions
Vendor Agreements
Audits and Monitoring
 ­ ­ ­  Billing and Docume­ntation
 ­ ­ ­  Contract Review
 ­ ­ ­  Controlled Substance Inventory
 ­ ­ ­  Personnel Docume­ntation Review
 ­ ­ ­  Billing: Medicare Part A (Triple Check)
 ­ ­ ­  Billing: Medicare Part A (Therapy Docume­nta­tion)
 ­ ­ ­  Billing: Medicare Part B (Therapy Docume­nta­tion)