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Pick and choose what you need from this thorough Policies & Procedures Manual. This downloadable manual includes the following:
Policy and Procedure Manual
Table of Contents
CHAPTER 1: POLICY DEVELOPMENT AND MAINTENANCE Policy #
Development and Administration.......................................................................................... 105
Forms........................................................................................................................................... 110
CHAPTER 2: PERSONNEL
Salary Determination................................................................................................................. 200
Provider Time Out .................................................................................................................... 205
Orientation and Training.......................................................................................................... 215
Performance Evaluations.......................................................................................................... 220
SMART Performance Evaluations........................................................................................... 221
Job Shadowing............................................................................................................................ 222
Mentoring Program................................................................................................................... 223
Property/Equipment Usage..................................................................................................... 225
Co-worker / Department Recognition Award...................................................................... 235
Patient Recognition Award……………………………………………………………………236
Staff Uniforms…………………………………………………………………………………..240
Employee Courtesy Discounts................................................................................................. 245
Reimbursed Expenses................................................................................................................ 250
Waiver of Health Insurance...................................................................................................... 255
Time Clock Instructions............................................................................................................ 260
PTO Cash Out............................................................................................................................. 265
Donating PTO............................................................................................................................. 270
Secondary Employment/Treatment or Services Outside of {YOUR PRACTICE}.......... 275
CHAPTER 3: APPOINTMENT SCHEDULING
General Appointment Scheduling Overall Guidelines........................................................ 300
Appointment Scheduling.......................................................................................................... 305
Notes in Drawer………………………………………………………………………………..306
Appointment Override.............................................................................................................. 310
Delinquent Balance Appointment........................................................................................... 315
Appointment Status................................................................................................................... 320
Missed Appointments --- see Policy 580 under Patient Communication
Appointment Reminders.......................................................................................................... 330
Appointment Scheduling Protocols........................................................................................ 335
Preparing for Daily Appointments.......................................................................................... 340
Late Arrivals............................................................................................................................... 345
Follow-up Appointments.......................................................................................................... 350
Cancellations............................................................................................................................... 355
Waiting Lists............................................................................................................................... 360
Reschedule List........................................................................................................................... 365
Call Triage and Scheduling...................................................................................................... 370
Urgent Care Guidelines............................................................................................................. 375
CHAPTER 3: APPOINTMENT SCHEDULING, continued Policy #
Scheduling Self Pay Patients.................................................................................................... 380
Partnership Health Referrals.................................................................................................... 383
Scheduling Medicaid Patients.................................................................................................. 385
Call Policy.................................................................................................................................... 390
Physician Scheduling ................................................................................................................ 393
Scheduling for Physician Assistants (PAs)............................................................................. 395
CHAPTER 4: REGISTRATION
Patient Account Assignment.................................................................................................... 405
New Patient Registration.......................................................................................................... 410
PSR Check-in……………………………………………………………………………………411
New Patient Check-in................................................................................................................ 415
Established Patient Check-in.................................................................................................... 420
Patient Check-out....................................................................................................................... 425
Satellite Clinics........................................................................................................................... 430
Treatment of Minors.................................................................................................................. 435
Self Pay Patients and Collecting Co-payments see Policy 380 under Appointment Scheduling
Workers’ Compensation Patients............................................................................................ 455
Mail Sorting................................................................................................................................. 460
Retrieving Faxes......................................................................................................................... 462
Alert Notes.................................................................................................................................. 470
Reception Department Orientation and Training................................................................. 495
CHAPTER 5: PATIENT COMMUNICATION
Telephone Greeting Standards................................................................................................. 505
Telephone Communications..................................................................................................... 510
Patient Account Inquiries......................................................................................................... 530
Written Account Inquiries........................................................................................................ 540
Answering Service Transfer..................................................................................................... 550
Response to Patient Concerns.................................................................................................. 560
Patient Discharge....................................................................................................................... 570
Patient Missed Appointments “No Shows”........................................................................... 580
Patient Surveys........................................................................................................................... 590
CHAPTER 6: MEDICAL RECORDS/TRANSCRIPTION
Medical Chart............................................................................................................................. 605
Storage and Retrieval of Medical Records............................................................................. 610
Chart Information Organization.............................................................................................. 615
Authorization to Release........................................................................................................... 620
Restriction for Use & Disclosure of PHI................................................................................. 621
Faxing Records from the Electronic Medical Records………………………………………623
Signature Log.............................................................................................................................. 625
Copying of Patient Records...................................................................................................... 630
Confidentiality............................................................................................................................ 635
Dictation...................................................................................................................................... 640
Purging........................................................................................................................................ 645
CHAPTER 6: MEDICAL RECORDS/TRANSCRIPTION, continued Policy #
Destruction of PHI..................................................................................................................... 646
Subpoena Compliance............................................................................................................... 650
Subpoena Duces Tecum............................................................................................................ 655
Court Orders............................................................................................................................... 660
Search Warrant........................................................................................................................... 665
Medical Records Department Orientation and Training..................................................... 679
Transcription Procedures.......................................................................................................... 680
Transcription Notes Format..................................................................................................... 685
Saving/Printing Documents.................................................................................................... 686
Medical Spell check.................................................................................................................... 687
Using WinScribe and VPN....................................................................................................... 695
Transcription Department Orientation and Training........................................................... 699
CHAPTER 7: PATIENT CLINICAL CARE / URGENT CARE
On Call vs. Town Call --- see Policy 370 under Appointment Scheduling
Patient Clinical In-take.............................................................................................................. 705
Medical Emergencies................................................................................................................. 710
Return to Work-Medical Status Report Form........................................................................ 715
Back Office On-call..................................................................................................................... 720
Physician Call Trade Notification............................................................................................ 730
Home Health Certification Forms........................................................................................... 750
Minor Procedures in the Procedure Room............................................................................. 755
PRP Injections............................................................................................................................. 756
Ordering and Performing EKGs………………………………………………………………757
Scheduling {YOUR PRACTICE} Surgeries in Centricity..................................................... 760
Urgent Care Physician Assistant Coverage........................................................................... 770
Urgent Care Physician Coverage............................................................................................. 780
Urgent Care Protocols --- see Policy 375 under Appointment Scheduling
Orthopedic Assistants Working from Home......................................................................... 790
Treatment and/or Service at Facilities Outside of {YOUR PRACTICE} Employment... 793
Back Office Orientation and Training..................................................................................... 795
Sports Physical Screenings…………………………………………………………………….796
CHAPTER 8: BENEFITS/PRE-AUTHORIZATIONS
Benefit Eligibility........................................................................................................................ 800
Surgical Estimates...................................................................................................................... 820
MRI Estimates............................................................................................................................. 830
Workers’ Compensation Authorization................................................................................. 840
Pre-Authorizations for Referrals to Outside Faciliities…………………………………….850
CHAPTER 9: MEDICATION MANAGEMENT
Medication Management.......................................................................................................... 900
Safe Injection Practices.............................................................................................................. 905
Tetanus Shot Documentation………………………………………………………………….906
Pharmaceutical Representatives/Visitors.............................................................................. 910
Sample Medications................................................................................................................... 915
Dental Prophylaxis Protocols................................................................................................... 920
EPI Injection for Allergic Emergencies................................................................................... 921
CHAPTER 10: ANCILLARY TEST REPORTING
Test Result Follow-up............................................................................................................... 1005
Initialing Test Results............................................................................................................... 1010
CHAPTER 11: X-RAY
X-Ray Safety and General Policies.......................................................................................... 1105
STAT Read for X-rays............................................................................................................... 1106
Transferring Patients-Unable to Perform Exam................................................................... 1107
X-ray Staffing............................................................................................................................. 1110
X-ray Storage and Retrieval..................................................................................................... 1115
USB Drive for Use in Surgery.................................................................................................. 1117
X-Ray Image Tracking................................................................................................................ 1120
Digitizing Protocol.................................................................................................................... 1125
Deleting X-ray Images from DR Machine............................................................................. 1127
E-mailing Images from Office PACS...................................................................................... 1130
Charging for CDs...................................................................................................................... 1135
X-Rays for Outside Physicians................................................................................................ 1140
X-ray Informed Consent for Pregnant or Potentially Pregnant Patients.......................... 1141
Ordering X-rays for {YOUR PRACTICE} Employees…………… ………………………1142
X-Ray Department Orientation and Training....................................................................... 1195
CHAPTER 12: DURABLE MEDICAL EQUIPMENT (DME)
Overall DME Policies................................................................................................................ 1205
DME Collections........................................................................................................................ 1210
DME Given at Schools…………………………………………………………………………1215
DME Department Orientation and Training........................................................................ 1295
CHAPTER 13: RISK MANAGEMENT AND QUALITY IMPROVEMENT
Process Improvement and Utilization Management........................................................... 1305
Accuracy and Completeness of Charges............................................................................... 1310
Accident/Incident Investigation Report............................................................................... 1320
Safety and Health Rules........................................................................................................... 1325
Record Retention....................................................................................................................... 1330
Emergency Action Plan-Office Invasion or Threat (Code Silver Policy).......................... 1333
Incident/Emergency Alert Notification................................................................................ 1335
Disaster Plan……………………………………………………………………………………1336
Treating Prison Inmates........................................................................................................... 1340
Student Internships and Job Shadowing............................................................................... 1345
CHAPTER 14: INFORMATION SYSTEMS
Data Back-up Procedures......................................................................................................... 1405
Month-end Closing................................................................................................................... 1410
Year-end Closing....................................................................................................................... 1415
Outlook Email Signatures…………………………………………………………………….1420
Information Help Desk............................................................................................................. 1430
Disaster Management............................................................................................................... 1435
Security Level Designations.................................................................................................... 1445
Electronic Communication...................................................................................................... 1450
Copyright and Legal Issues..................................................................................................... 1455
Internet Security........................................................................................................................ 1465
Passwords................................................................................................................................... 1470
CHAPTER 14: INFORMATION SYSTEMS, continued Policy #
Workstations.............................................................................................................................. 1475
Information Security Agreement............................................................................................ 1480
Conference Phone Usage......................................................................................................... 1490
CPOE (Computerized Provider Order Entry)………………………………………………1495
CHAPTER 15: FINANCIAL MANAGEMENT
Bank Reconciliation Process.................................................................................................... 1510
Check Signing............................................................................................................................ 1515
Charge Card Authorizations................................................................................................... 1520
Petty Cash Transactions........................................................................................................... 1530
Budget......................................................................................................................................... 1540
Month-end Closing................................................................................................................... 1545
Deposit of Patient Receipts...................................................................................................... 1550
Charitable Contributions.............................................................................................................. 1565
CHAPTER 16: MATERIALS MANAGEMENT
Purchasing Control................................................................................................................... 1605
Pricing Discounts...................................................................................................................... 1615
Group Purchasing..................................................................................................................... 1620
Maintenance/Leasing Contracts............................................................................................. 1625
Equipment and Service Requests............................................................................................ 1630
Terms for Borrowing Equipment see Policy 225 under Personnel
Materials Management Department Orientation and Training......................................... 1695
CHAPTER 17: COMPLIANCE
Exposure Control Plan............................................................................................................. 1705
Hazard Communication Program.......................................................................................... 1710
Hand Washing........................................................................................................................... 1715
Exam/Procedure Room Cleaning.......................................................................................... 1716
Universal Precautions............................................................................................................... 1720
Sharps and Needlestick............................................................................................................ 1725
Compliance................................................................................................................................ 1730
Risk Management...................................................................................................................... 1735
New Employee OSHA Orientation........................................................................................ 1740
CHAPTER 18: FACILITIES
Fire Control and Evacuation................................................................................................... 1805
Secure Environment.................................................................................................................. 1810
Clean Environment................................................................................................................... 1815
Facility Cleaning Schedule....................................................................................................... 1825
Security Alarm........................................................................................................................... 1830
CHAPTER 19: BILLING/ACCOUNTS RECEIVABLE
Superbill Form........................................................................................................................... 1900
Offsite Charges.......................................................................................................................... 1902
Coding........................................................................................................................................ 1904
CPC Certification and Conference Allowance...................................................................... 1905
Charge Entry.............................................................................................................................. 1906
Charging for Satellite Clinic Patients………………………………………………………..1907
Accurate and Timely Data Entry............................................................................................ 1908
CHAPTER 19: BILLING/ACCOUNTS RECEIVABLE, continued Policy #
Charge and Appointment Reconciliation.............................................................................. 1910
Charge Correction..................................................................................................................... 1914
Billing Third Party Payers........................................................................................................ 1916
Private or Indemnity Carriers................................................................................................. 1918
Billing Secondary Insurance.................................................................................................... 1920
Billing Tertiary Insurance........................................................................................................ 1922
Claim Edits................................................................................................................................. 1924
Payment Posting........................................................................................................................ 1926
Payment Posting – Bank Deposit............................................................................................ 1928
Payment Posting – Interest Payments.................................................................................... 1930
Credit Card Payments.............................................................................................................. 1931
Credit Balances and Refunds.................................................................................................. 1932
Counterfeit Money…………………………………………………………………………… 1933
Claim Denials............................................................................................................................. 1934
Insurance Follow-up................................................................................................................. 1936
Patient Balance Follow-up....................................................................................................... 1938
Contractual Adjustments......................................................................................................... 1940
Patient Small Balances.............................................................................................................. 1942
Budget Plan................................................................................................................................ 1944
Collection Agency Policy......................................................................................................... 1946
Collection Account Payment................................................................................................... 1948
Alert Notes -- see Policy 470 under Registration
Bankruptcy................................................................................................................................. 1950
Financial Hardship................................................................................................................... 1952
Deceased Patients / Estates..................................................................................................... 1954
Workers’ Compensation.......................................................................................................... 1956
Bad Address............................................................................................................................... 1958
Non-sufficient Funds................................................................................................................ 1960
Collection Process..................................................................................................................... 1962
Collection Disputes................................................................................................................... 1964
Financial Policy......................................................................................................................... 1966
Fracture Care…………………………………………………………………………………...1967
Financial Arrangements for Surgery--- see Policy 820 under Benefits/Pre-Authorizations
Tribal Health Medicaid VA FRAF……………………………………………………………1971
Medicare Non-Covered Services – ABN............................................................................... 1972
Funds Transfer........................................................................................................................... 1974
Cash Discounts.......................................................................................................................... 1976
Employee Discounts--- see Policy 245 under Personnel
Charges for Physicians and Family Members...................................................................... 1980
Charging for Miscellaneous Forms and JAs......................................................................... 1982
Depositions and IMEs.............................................................................................................. 1984
Minors of Divorced Parents..................................................................................................... 1986
Coding and Documenting Consults....................................................................................... 1988
Collecting Co-Payments and Full Pay Patients.................................................................... 1990
Incorrect/Incomplete Patient Demographics....................................................................... 1992
Maximum Medical Improvement (MMI).............................................................................. 1994
Tricare Policy…………………………………………………………………………………..1995
Patient Visits Split Between W-Comp. and Insurance........................................................ 1996
CHAPTER 19: BILLING/ACCOUNTS RECEIVABLE, continued Policy #
Patients Seeing Two Providers on the Same Day................................................................. 1997
Orientation and Training - Cashier........................................................................................ 1998
Orientation and Training – A/R……………………………………………………………..1999
CHAPTER 20: SURGERY CENTER
Surgery Scheduling................................................................................................................... 2005
Financials Guidelines............................................................................................................... 2010
Budget Plan................................................................................................................................ 2011
Procedures Requiring an ABN Form..................................................................................... 2015
IV Antibiotic Charging............................................................................................................. 2020
Vendors....................................................................................................................................... 2080
Surgery Center Department Orientation Checklist............................................................. 2095
Sterling Select Patients………………………………………………………………………...2096
CHAPTER 21: PHYSICAL THERAPY
Sports Medicine Outreach Hours/Mileage........................................................................... 2100
ASTYM Certification................................................................................................................ 2103
Physical Therapy Appointment Scheduling......................................................................... 2105
Scheduling Co-treatment Appointments Between PT and Clinic..................................... 2106
New Patient Check-in............................................................................................................... 2107
Established Patient Check-In................................................................................................... 2108
New Patient Registration......................................................................................................... 2109
Benefit Eligibility....................................................................................................................... 2110
Collecting Co-payments........................................................................................................... 2111
PT Self-pay Patients.................................................................................................................. 2120
Patient Check-out...................................................................................................................... 2121
Follow-up Appointments......................................................................................................... 2122
Cancellations.............................................................................................................................. 2124
Appointment No-Shows and Short-term Cancellations..................................................... 2125
Charge Entry.............................................................................................................................. 2130
Workers Compensation Authorizations................................................................................ 2132
Patient Safety Precautions for Clinic Treatments................................................................. 2140
Record Documentation............................................................................................................ 2141
PT Low Census.......................................................................................................................... 2190
Physical Therapy Staffing........................................................................................................ 2191
CHAPTER 22: MRI
Prescribing Valium for MRI Patients..................................................................................... 2246
MR Arthrogram Protocol......................................................................................................... 2247
Extravasation Policy................................................................................................................. 2248
MRI Contrast.............................................................................................................................. 2249
Scheduling MRIs....................................................................................................................... 2256
MRI No Show Policy................................................................................................................ 2257
MRI Staffing Protocol............................................................................................................... 2258
{PRACTICE} MR Environment Zoning................................................................................. 2270
MRI Employee Training Policy............................................................................................... 2271
Patient and Personnel Safety................................................................................................... 2272
MR Infection Control................................................................................................................ 2273
MRI Acute Medical Emergencies........................................................................................... 2274
CHAPTER 22: MRI, continued Policy #
MRI Pediatric Safety................................................................................................................. 2275
MR Education, Training and screening................................................................................. 2276
MR Environment Safety Policy............................................................................................... 2277
Accident-Incident MRI............................................................................................................. 2278
Equipment and Room Cleaning Policy.................................................................................. 2279
Correlation Policy..................................................................................................................... 2280
Management of Patient Reports.............................................................................................. 2281
Primary Source Verification Policy........................................................................................ 2285
MRI Orientation and Training……………………………………………………………….2290
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