Main

I.H.

At a minimum, all settings where sedation or anesthesia is administered should have the following equipment for resuscitation purposes:

I.Q.

A written policy outlines appropriate hand hygiene using products according to the product manufacturer’s instructions for use 

I.B.02

Based on nationally-recognized infection prevention and control guidelines considered and selected by the governing body. 

III.C.

In solo physician or dental organizations, an outside physician or dentist is involved to provide peer-based review. 

II.B.5.b

Upon reciept of a completed reappointment application, the organization will conduct primary or secondary source verfication items listed in Standards 2.II.B.3.c-f.  At the time of reappointment consideration by the governing body, the entire reappointment application and the peer review activities and results, completed in accordance with Chapter 2.III, will be considered.

Notes: 
UC Policy
Location: 
Credentialing of Professional Staff

II.B.5.a

Completion of a formal reappointment application which includes, at a minumum:

1. Updated personal information

2. Completed attestation questions found in 2.II.B.3.g.

3. A formal statement releasing the organization from any liability in connection with credentiallng decisions

4. A formal statement confirming that the information submitted is accurate and complete

5. Applicant signature and date

Notes: 
UC Policy
Location: 
Credentialing of Professional Staff

ORTHO SLIPS

Effective Date: 
Tue, 11/22/2016
Policy: 

Ortho slips are checked to ensure billing is complete.

Procedure: 
  • Acquire ortho slips and sort by date and patient
  • Open visit note for that patient and date
  • Review visit note for appropriate documentation and billing.  Search under supplies (already billed) and in the body of the note, under Nursing, in Activity and in any Addendum
  • If documented and billed, securely shred ortho slip
  • If documented and NOT billed: Add addendum stating "Dispensed certain product (with code number on line 2)
  • IM biller to alert to add product to patient ticket
  • Securely shred completed ortho slips 
  • If NOT documented, review visit and if probable, add addendum to complete the documentation with product and code number, then IM biller to alert to add product to patient ticket
  • If not probable, then IM the clinician to ask if dispensed to patient; follow up as necessary
  • Securely shred completed ortho slips 

MEDICAL CODING AND BILLING COMPLIANCE

Effective Date: 
Thu, 10/06/2016
Policy: 

The University of California Santa Cruz Student Health Services complies with the OIG Medical Billing and Coding Compliance Requirements.  Staff are trained and updated regularly (note: ICD-10).  These include the seven components for a voluntary compliance program:

• Conducting internal monitoring and auditing;

• Implementing compliance and practice standards;

• Designating a compliance officer or contact;

• Conducting appropriate training and education;

• Responding appropriately to detected offenses and developing corrective action;

• Developing open lines of communication; and

• Enforcing disciplinary standards through well-publicized guidelines

The compliance guidelines are available via the attached link.

MONTHLY PAPR BATTERY CHECK

Form Type: 
HC
Form Number: 
951

INSURANCE AND BILLING REQUEST TRACKER

Effective Date: 
Mon, 06/20/2016
Policy: 

All inquiries for the Insurance and Billing Departments at UCSC Student Health Services will be funneled through the UCSC Request Tracker (RT) for Insurance and Billing.  The Request Tracker is not a secure system and any content that contains PHI must be removed and responded to securely and if necessary documented in the EMR under Admin Notes.

This customer service documentation and resolution system provides auto-replies and standardized answers to common questions.  It is also a continuous documentation system that allows for follow up or allows return to a topic or request since that information and data are retrievable, and all communications that are received are addressed in an orderly and timely fashion.  The goal is to have as much resolved as possible at the first contact.

Any communications from outside providers or which contain referral requests or PHI will be prioritized. 

Staff will complete the shared daily tasks to make sure that all duties are complete.

Utilization and productivity data will be collected monthly via built in reports.

Procedure: 

Insurance and Billing advocates will manage all inquiries through the UCSC Request Tracker.  The advocates will follow specific procedures listed in the RT Binder and other communication methods.

Insurance and Billing advocates will monitor the RT queue and each will "take" or transfer ownership of the oldest ticket and respond to the ticket as appropriate with articles that provide standardized text on common questions or specific answers as necessary.  Tickets that are tagged as needing referral assistance are prioritized due to possible timely need of information and/or content that contains PHI, which must be removed, and addressed  securely.

Once a ticket is "taken" then it is "open".  Once the inquiry is addressed, then the ticket can be changed to "resolved".  If necessary, the ticket can be designated as "stalled" which means it is pending due to the need for additional information prior to resolution.

An advocate can tag a ticket with another staff member's name if that staff member has already been working with the case.

EMAILS

All emails sent to insure@ucsc.edu automatically go into the RT.

PHONE CALLS AND WALK-INS

Phone calls and walk-in inquiries that can be answered with a quick response do not need to be entered into the Request Tracker. All other requests will be entered into the Request Tracker and responded to according to established procedures. 

Referrals or other inquiries containing PHI will be managed securely through the EMR.

 

 

 

 

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