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9780834217447

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

by
  • ISBN13:

    9780834217447

  • ISBN10:

    0834217449

  • Edition: Disk
  • Format: Paperback
  • Copyright: 2000-04-01
  • 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.

Table of Contents

Preface ix
Measuring Performance in Primary Care
1(18)
Perspectives on Quality
1(2)
Watchdogs Step in Where Professional Societies Held Back
3(1)
Federal Government Efforts
3(1)
The Court System as Enforcer
4(1)
An Era of Attention to Consumer Needs
4(1)
Who Will Measure and Report Quality?
4(1)
How Are Health Plans Performing on Quality Evaluations?
5(1)
The Measures
6(7)
Future Measures
13(2)
HEDIS Measures
15(1)
Emerging Awareness
16(3)
Systems for Meeting Benchmarks for Screening and Health Maintenance
19(40)
Avoiding Poor Report Cards
19(1)
The Problems with PPIP
20(2)
Making Compliance a Sure Thing
22(37)
Personal Health Guide from Put Prevention Into Practice
24(9)
Child Health Guide from Put Prevention Into Practice
33(10)
Personal Prevention Record
43(1)
Adult Preventive Care Flowsheet
44(1)
Child Preventive Care Flowsheet
45(1)
Child Immunization Flowsheet
46(2)
Performance Standards for PCPs
48(1)
Health Care Maintenance Tracking Form-Adults
49(1)
Diabetic Patient Follow-up Flowsheet
50(1)
Asthmatic Patient Follow-up Flowsheet
51(1)
Hospital Discharge Follow-up Flowsheet
52(1)
Prenatal Care Tracking Form
53(1)
Postcard for Adults from Put Prevention Into Practice
54(1)
Postcard for Parents from Put Prevention Into Practice
55(1)
Sources of Materials That Clinicians Can Use To Increase Preventive Services
56(1)
Selected Codes Sought in HEDIS Audits
57(1)
Questions PCP Staff Should Ask Patients at Each Visit
58(1)
Measuring Outcomes in Primary Care
59(6)
Advantages of Practice-Level Outcome Studies
60(1)
Outcome Measures Distinguished from Performance Measures
61(1)
Barriers to Measuring Outcomes
61(1)
Arguments for Moving Past the Barriers
61(1)
Public Reporting of Outcome Data
62(1)
Principles of Outcomes Measurement
62(1)
Process
63(2)
Systems for Measuring Outcomes at the Practice Level
65(10)
Steps for Measuring Practice-Level Outcomes
65(5)
Balancing Time and Options
70(5)
Example: Outcomes Measurement Process for Patients with Hypertension
71(4)
Systems for Tracking Functional Status
75(10)
The SF-12 Health Survey
79(2)
Functional Status Tracking Form
81(2)
Short Form for Tracking Seniors' Functional Status
83(2)
Systems for Measuring and Tracking Patient Satisfaction
85(36)
Tools
85(1)
CAHPS Content
86(1)
What Patients Want
86(1)
Systems for Ensuring High Levels of Patient Satisfaction
87(34)
CAHPS Adult Core Questionnaire
89(9)
CAHPS Adult Supplemental Questions
98(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

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The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

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