JustCoding.com: HIM

Platinum form: POA indicator query form

Use this form to conduct present on admission queries.

Benefit investigation form

Beth Beers, coding and reimbursement specialist for the oncology/hematology clinic at Mercy Hospital in Portland, ME, developed this tool to help make providers aware of insurance coverage information prior to treatment. Use this form to determine whether the patient has coverage for the treatment, whether there is a high deductible for the treatment, whether the patient can pay for the treatment, and whether there are any assistance programs that will help the patient pay for services and medications.

Patient tracer worksheet

Admission, history, and physical examination tracking form

Use this form to track documentation for admission, history, and physical examination. This form was excerpted from HCPro's book, Ongoing Records Review: A Guide to JCAHO Compliance and Best Practice. For more information, visit http://www.hcmarketplace.com/prod-5043.html.

H&P critical elements pre-surgery tracking form

Use this form to help track critical elements in the history and physical. This form was excerpted from HCPro's book, Ongoing Records Review: A Guide to JCAHO Compliance and Best Practice. For more information, visit http://www.hcmarketplace.com/prod-5043.html. Source: Ongoing Records Review, Fifth Edition: A Guide to The Joint Comission Compliance and Best Practices, reprinted with permission. For more information visit: http://www.hcmarketplace.com/prod-5043.html.

Ongoing records review process assessment

Use this form to help assess your ongoing records review process. Source: Ongoing Records Review, Fifth Edition: A Guide to The Joint Comission Compliance and Best Practices, reprinted with permission. For more information visit: http://www.hcmarketplace.com/prod-5043.html.

Clinical Documentation Improvement Program Case Manager's Training Session

Use this exam to test case managers after your clinical documentation improvement program training session. Source: Guide to Inpatient Clinical Documentation Improvement Strategies to Ensure Compliance and Correct Reimbursement, reprinted with permission. For more information visit http://www.hcmarketplace.com/prod-1047.html

Protocol for a medical records committee with ongoing records review

Use this form to help develop a protocol for a medical records committee with ongoing records review oversight. Source: Ongoing Records Review, Fifth Edition: A Guide to The Joint Comission Compliance and Best Practices, reprinted with permission. For more information visit: http://www.hcmarketplace.com/prod-5043.html.

Request for accounting of disclosures

Use this sample form to requent accounting of disclosures.

Disclosure form

Use this sample form to track disclosures. Source: Marshalltown (IS) Medical and surgical Center. Reprinted with permission.

Explanation of benefit audit tool

Track denials with this explanation of benefit audit tool in Excel. Source: Denial Management: Key Tools and Strategies for Prevention and Improvement For more information visit http://www.hcmarketplace.com/prod-3659.html

HIM department customer-satisfaction form

Use this sample form to quantify customer satisfaction pertaining to the HIM department. Source: McAlester (OK) Regional Health Center. Reprinted with permission.

Sample confidentiality of patient and hospital information form

Use this sample form to ensure confidentiality of all patient and hospital information. Source: Adapted from Memorial Hospital of Union County, Marysvill, OH. Reprinted with permission.

Request for restrictions on protected health information

Use this form to request restrictions on protected health information. Source: Medical College of Ohio Hospitals. Reprinted with permission.

Inpatient-coding audit tool

Checklist of criteria for auditing firms

Physician delinquency assessment

Use this form to create a delinquency profile for your physicians. Source: More With Less, Second Edition: Best Practices for HIM Directors, reprinted with permission. For more information visit: http://www.hcmarketplace.com/prod-5170.html

Transcription productivity report

Use this form to measure transcription productivity. Source: Southeastern Ohio Medical Center, Cambridge. Reprinted with permission.

Unapproved abbreviations review tool

Disseminate this list to your coding staff so that they may track physician usage of unapproved abbreviations. Source: Ongoing Records Review, Fifth Edition: A Guide to The Joint Comission Compliance and Best Practices, reprinted with permission. For more information visit: http://www.hcmarketplace.com/prod-5043.html.

Workday assessment form

Use this form to assess coders' workdays and improve employee satisfaction and retention. McAlester (OK) Regional Health Center. Reprinted with permission

Case manager self-evaluation form

Use this form to perform a case manager self-evaluation to assess coding and documentation improvement knowledge before implementing a clinical documentation improvement program. Source: Guide to Inpatient Clinical Documentation Improvement Strategies to Ensure Compliance and Correct Reimbursement, reprinted with permission. For more information visit http://www.hcmarketplace.com/prod-1047.html

72-hour/account transfers

Use this form for 72/-hour/account transfers for different dates of service. If the transfer is during the same day, use one of the other duplicate forms. Source: Marshaltown (IA) Medical & Surgical Center. Reprinted with permission

Data collection tool

Use this data collection tool to determine a monthly tally of denials. Source: Denial Management: Key Tools and Strategies for Prevention and Improvement, reprinted with pernmission. For more information visit http://www.hcmarketplace.com/prod-3659.html

Hospital concurrent documentation improvement plan sample policy

Thinking about starting a concurrent documentation program? Use this sample policy as a foundation. Source: Guide to Inpatient Clinical Documentation Improvement Strategies to Ensure Compliance and Correct Reimbursement, reprinted with permission. For more information visit http://www.hcmarketplace.com/prod-1047.html

Sample claims tracking report for third-party payers

Use this sample claims tracking report to stay abreast of payments made by third-party payers. Source: Revenue Cycle Management: A Best Practices Toolkit, reprinted with permission For more information visit: http://www.hcmarketplace.com/prod-4003.html

Coding quality review for outpatient records

HIPAA complaint form

Use this form to report a privacy disclosure complaint. Source: Granville (NC) Medical Center. Reprinted with permission