Professional Documents
Culture Documents
Self Audit DOS 10/12/2017
Self Audit DOS 10/12/2017
**Sun, Richard – Summary says “ACP discussed on 1/17, will discuss on next visit” ACP(Advanced Care
Planning 99497 can be billed once in 6 months). Providers mention in summary as “ACP discussed”. I
need to check all previous visits and go back 6 months to find if ACP is required for the visit which makes
billing complicated.
SUGGESTION: All providers can create a sub-header like injection description for ACP and mention next
due date and when it was done previously.
Example
ACP:
***Few providers do not mention CBC description in summary but when checked in medcom I find CBC
was done. I do not have an example for this but this happens once in a while.
SUGGESTION: All providers can create a sub header for CBC and mention whether it was seen today or if
they are mentioning a previous CBC
Example:
CBC:
***Injections by MA - MA’s at satellite office can mention if the injection was PDP or outside RX as well
as we provide in injection description as earlier which was helpful. At times they are missing to enter in
in house reports(Inventory)
Example: 2 injections were given on 12/27/2017 at satellite office but couldn’t find details in inventory-
in house reports.
DOS 12/27/2017 patient name Rice Shirley, ZAHL Merton injections were not pulled in inhouse reports.
****Smoking cessations- In summary providers can create a sub header for smoking cessation as well.
Example:
Smoking cessation discussed-duration 10 minutes- This will be helpful for me to bill 99406
***Insurance Eligibility:
Eligibility team replaces inactive insurance in the demographics tab. For example patient has cal optima
until 12/31/2017 and active with medicare from 1/1/2018. When I post dos 12/22/2017 I see Genius
picks up active insurance which is Medicare. This is incorrect as claim should go to Cal optima for dos
billed. So eligibility team should mention effective and termination date in genius doc and should not
replace old insurance with new one which I see around 3-4 cases a month. I come to know about this
when inventory has old insurance pulled since it has old data. I then go to eligibility excel and add old
insurance id # which is really time consuming and can be simplified.
***DOS 10/12/2017- Groom, Catherine patient not found in inventory. I had to check with Johnny to
post the account since this was SCOA patient.
***DOS 10/12/2017-Duarte Trujillo Eliaser – GD shows VIDAZA WAS GIVEN ONLY 200 UNITS BUT IN GD
WE HAVE 100 WASTAGE AND 200 WAS GIVEN, INVENTORY SHOWS ONLY 200 with no Wastage. I have
posted as per inventory