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The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

by: Buppert, Carolyn, Crnp, Jd

The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

by: Buppert, Carolyn, Crnp, Jd

ISBN 13:
9780834217447
ISBN 10:
0834217449
Edition: Disk
Format: Paperback
Copyright: 04/01/2000
Publisher: JONES & BARTLETT PUB
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Summary

St. John's College, Annapolis, MD. Provides advice on growing patient enrollment in managed care health plans, performance evaluations by outside agencies, and dramatic increase in billing audits. CD-ROM includes customizable forms. Wire-spiral binding. System requirements: Windows 3.x, 95/98. DNLM: Quality Assurance, Health Care--methods.

Preface

Measuring Performance in Primary Care

(18)

Perspectives on Quality

(2)

Watchdogs Step in Where Professional Societies Held Back

(1)

Federal Government Efforts

(1)

The Court System as Enforcer

(1)

An Era of Attention to Consumer Needs

(1)

Who Will Measure and Report Quality?

(1)

How Are Health Plans Performing on Quality Evaluations?

(1)

The Measures

(7)

Future Measures

(2)

HEDIS Measures

(1)

Emerging Awareness

(3)

Systems for Meeting Benchmarks for Screening and Health Maintenance

(40)

Avoiding Poor Report Cards

(1)

The Problems with PPIP

(2)

Making Compliance a Sure Thing

(37)

Personal Health Guide from Put Prevention Into Practice

(9)

Child Health Guide from Put Prevention Into Practice

(10)

Personal Prevention Record

(1)

Adult Preventive Care Flowsheet

(1)

Child Preventive Care Flowsheet

(1)

Child Immunization Flowsheet

(2)

Performance Standards for PCPs

(1)

Health Care Maintenance Tracking Form-Adults

(1)

Diabetic Patient Follow-up Flowsheet

(1)

Asthmatic Patient Follow-up Flowsheet

(1)

Hospital Discharge Follow-up Flowsheet

(1)

Prenatal Care Tracking Form

(1)

Postcard for Adults from Put Prevention Into Practice

(1)

Postcard for Parents from Put Prevention Into Practice

(1)

Sources of Materials That Clinicians Can Use To Increase Preventive Services

(1)

Selected Codes Sought in HEDIS Audits

(1)

Questions PCP Staff Should Ask Patients at Each Visit

(1)

Measuring Outcomes in Primary Care

(6)

Advantages of Practice-Level Outcome Studies

(1)

Outcome Measures Distinguished from Performance Measures

(1)

Barriers to Measuring Outcomes

(1)

Arguments for Moving Past the Barriers

(1)

Public Reporting of Outcome Data

(1)

Principles of Outcomes Measurement

(1)

Process

(2)

Systems for Measuring Outcomes at the Practice Level

(10)

Steps for Measuring Practice-Level Outcomes

(5)

Balancing Time and Options

(5)

Example: Outcomes Measurement Process for Patients with Hypertension

(4)

Systems for Tracking Functional Status

(10)

The SF-12 Health Survey

(2)

Functional Status Tracking Form

(2)

Short Form for Tracking Seniors' Functional Status

(2)

Systems for Measuring and Tracking Patient Satisfaction

(36)

Tools

(1)

CAHPS Content

(1)

What Patients Want

(1)

Systems for Ensuring High Levels of Patient Satisfaction

(34)

CAHPS Adult Core Questionnaire

(9)

CAHPS Adult Supplemental Questions

(14)

CAHPS Sample Telephone Script

112

(9)

Malpractice: The Ultimate Failure in Quality

121

(12)

Incidence of Malpractice Lawsuits

122

(1)

Most Common Mistakes

122

(1)

Elements of Malpractice

123

(1)

Malpractice Scenarios

123

(2)

Summary of Legal Pitfalls in Primary Care

125

(1)

Deficiencies in Charting

126

(1)

The Process of a Lawsuit

126

(1)

Baseless Lawsuits

127

(1)

Patient Actions Short of a Successful Lawsuit

128

(1)

Conclusion

128

(5)

Four Cases against Primary Care Providers

129

(4)

Systems for Avoiding Malpractice

133

(22)

Systems To Avoid Diagnostic Errors

133

(2)

Systems for Tracking Follow-up

135

(1)

Systems for Optimizing Defense Efforts If a Lawsuit Is Filed

136

(1)

Avoiding Elements of Malpractice

137

(1)

Systems for Dealing with Mistakes, Angry Patients

138

(1)

Adopt the Principles of Risk Management from Hospital Practice

139

(1)

Special Advice for PCPs Who Perform Diagnostic Tests

140

(1)

Avoiding Malpractice Liability

140

(15)

Documentation: Dos and Don'ts

142

(2)

Problem List

144

(1)

Tracking Form for Abnormal Findings

145

(1)

Forms for Tracking Follow-up of Diagnostic Tests

146

(3)

Form for Tracking Referrals

149

(1)

Referral Form

150

(1)

Refill Tracking Form

151

(1)

Documentation of Telephone Advice to Patients

152

(1)

Self-audit of Medical Records

153

(2)

Reimbursement for Primary Care

155

(10)

Medicare

155

(1)

Medicaid

156

(1)

Indemnity Insurers

157

(1)

Managed Care Organizations

157

(2)

Billing

159

(1)

Direct Contracts for Health Services

160

(1)

Self-paying Patients

160

(1)

Conclusion

160

(5)

Glossary

162

(3)

What Is Fraud and Abuse in Billing?

165

(14)

Definitions

165

(1)

Billing Medicare

166

(2)

Health Care Fraud

168

(1)

Focus on Documentation

169

(1)

Good Faith Errors

169

(1)

More Examples of Charges

170

(1)

The Possibility of Getting Caught

171

(1)

Audits

171

(3)

Appeals

174

(1)

Defenses

175

(1)

Possible Administrative Actions

176

(1)

Risky Billing Practices

176

(1)

The Stark Laws

176

(1)

Rumor Control

177

(2)

Systems for Complying with Requirements of Medicare and Other Payers

179

(138)

Why Do Medical Practices Need New Systems?

179

(1)

How To Avoid Investigation

179

(2)

Compliance Programs

181

(4)

Legal Reviews of Contracts and Operating Procedures

185

(1)

Know the Rules

185

(3)

Choose a Code: HCFA Guidelines

188

(4)

How To Write a Medical Record Note That Passes Audit: HCFA Guidelines

192

(8)

Frequently Asked Questions about Billing

200

(1)

Common Billing Errors

201

(1)

Additional Dos and Don'ts when Choosing Codes

202

(1)

Tools for Helping Clinicians Bill Correctly

203

(1)

New Providers: The Medicare Provider Application

203

(1)

Avoiding Fraudulent Billing of Commercial Insurance

204

(1)

Special Billing Rules for Nurse Practitioners and Physician Assistants

204

(113)

Documentation Guidelines for Evaluation and Management Services: Health Care Financing Administration, 1997

211

(36)

Documentation Guidelines for Evaluation and Management Services: Health Care Financing Administration, 1995

247

(10)

Documentation Guidelines for Evaluation and Management Services: American Medical Association, 1999

257

(40)

History Taking: HCFA and AMA Documentation Guidelines Compared

297

(4)

Examination: HCFA and AMA Documentation Guidelines Compared

301

(2)

Medical Decision Making: HCFA and AMA Documentation Guidelines Compared

303

(3)

Criteria for Documenting Evaluation and Management Codes for Established Patients, Office Visits

306

(4)

Documentation of a Face-to-Face Counseling Visit

310

(3)

Documentation Guidelines from HCFA

313

(4)

How To Contract with Managed Care Organizations

317

(14)

Capitated Contracts

317

(1)

Some Basics about Capitation

318

(1)

Steps for Negotiating a Managed Care Contract

319

(1)

Gather Information

319

(2)

Do an Analysis of Risk

321

(2)

Prepare Lists of Included and Excluded Services

323

(1)

Evaluate the Company's Fee Schedule

323

(1)

Evaluate the Company's Non-monetary Contract Provisions

324

(1)

Prepare a List of Must-haves, Would-likes, and Do-not-needs

324

(1)

Negotiate the Contract

324

(1)

Important Contract Language

325

(2)

Issues To Guide Contract Review

327

(2)

Fulfilling the Contract

329

(2)

How To Maximize Reimbursement

331

(8)

See More Patients

332

(1)

Maximize Billings

332

(1)

Ensure That Payers Pay

333

(1)

Negotiate Better Fee Agreements

333

(3)

Physician Assistants and Nurse Practitioners

336

(1)

Give Employees Incentives To Bill Wisely

336

(3)

Appendix A---Checklist Documentation Forms

339

(66)

Cardiovascular Evaluation/Plan

340

(4)

Diabetic Evaluation/Plan

344

(4)

Gastrointestinal Evaluation/Plan

348

(4)

Gynecologic Evaluation/Plan

352

(4)

Multi-System Evaluation/Plan

356

(5)

Multi-System Evaluation/Plan---Adolescent

361

(6)

Multi-System Evaluation/Plan---School-age Child

367

(6)

Multi-System Evaluation/Plan---Infant

373

(5)

Musculoskeletal Evaluation/Plan---Adult

378

(5)

Musculoskeletal Evaluation/Plan---Adolescent

383

(5)

Musculoskeletal Evaluation/Plan---School-age Child

388

(4)

Psychiatric Evaluation/Plan

392

(3)

Upper Respiratory Complaint

395

(2)

Upper Respiratory Complaint---Child

397

(2)

General Evaluation/Plan

399

(6)

Index

405

Amazon no longer offers textbook rentals. We do!

The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

9780834217447

0834217449

Summary

Table of Contents

Supplemental Materials

Write a Review

Amazon no longer offers textbook rentals. We do!

The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

The Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued

9780834217447

0834217449

Summary

Table of Contents

Supplemental Materials

Write a Review

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