Medicare billing assurance toolkit - step by step guide
The 5 Steps in the Toolkit make up a continuous improvement cycle for your practice’s Medicare billing assurance approach.
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The different sections of the Toolkit give you the tools to implement a continuous improvement cycle for your practice’s Medicare billing assurance approach. The following steps help you identify risks, implement strategies, monitor progress and measure results.
It is recommended that a complete cycle is carried out regularly—such as on an annual basis—so that your practice has access to up-to-date information on its Medicare billing assurance performance.
Step 1 - Pre-participation questionnaire
Give health professionals in your practice copies of the Pre-participation questionnaire before undertaking a Medicare billing assurance review.
This will help you to get an insight into what they think about the state of Medicare compliance in your practice.
While there are no right or wrong answers, you need to be comfortable with your practice’s risk levels as indicated by the responses to each question.
Over time, you can gather information on how perceptions and attitudes have developed in your practice to help you identify trends about Medicare billing assurance to focus on.
Step 2 - Self-assessment
The Practice self-assessment checklist helps to identify your practice's strengths and areas for improvement in its Medicare assurance approach.
It can be completed by your designated Medicare billing assurance person or you can encourage all the health professionals in your practice to complete the checklist to provide a whole-of-practice perspective.
The responses to this checklist are for your practice's internal use only and do not need to be disclosed to the department.
While there are no right or wrong answers, you need to be comfortable with your practice's risk levels indicated by your responses to each question. You can tick more than one box per question.
Step 3 - Assurance
This Toolkit includes strategies, templates and sample documents to help you improve your practice’s Medicare assurance approach.
The Medicare billing assurance charter sets out the principles that support your practice's billing activities under Medicare.
Your practice may consider adopting this Charter as part of its Medicare billing assurance approach.
The Medicare billing assurance manual template can help practices develop a Medicare billing assurance manual. It is not a prescriptive instrument and practices are encouraged to customise the sections according to their own requirements.
If your practice does not have documented Medicare billing assurance policies or procedures, you can use the Manual as a starting point.
If your practice has an existing documented Medicare billing assurance manual or existing Medicare billing assurance procedures, consider reviewing them against the sections in the Manual to identify any gaps or areas for improvement.
Step 4 - Post-participation questionnaire
When you have finished implementing the changes resulting from your Medicare billing assurance review, give copies of the Post-participation questionnaire to health professionals in your practice and compare the responses with the Pre-participation questionnaire.
While there are no right or wrong answers, you need to be comfortable with your practice's risk levels as indicated by the responses to each question.
When used with the Pre-participation questionnaire, you can see if there's been a difference in your practice's risk profile as a result of doing a Medicare billing assurance review and adopting one or more strategies to address the identified risks.
Step 5 - Share your results
Share the results with the health professionals in your practice and encourage feedback and suggestions on other ways your practice can improve Medicare billing accuracy.