Practice Analysis-Evaluation On-Site Consultation Service

While the regulation pertaining to the Annual Evaluation Report changed in 2019 to being required once every two years instead of annually, it is still VERY important to understand this regulatory change did not impact the ability of the State Inspector to conduct their surprise survey any time they want.

Failure to have this report on-hand with the State conducts the re-certification inspection WILL result in numerous citations for being out of compliance with the applicable regulations.

Here’s what one Healthcare Horizon client had to say about this service:

“Just wanted to thank you for all of your help! We have been a RHC for 7 years and have had only our certification survey until July 26th this year when they walked in.
 Your annual report saved us plus all the things you told us to do to prepare for it. Even the surveyor said you were awesome after he looked at the annual report. He asked me 3 times “now who did this?” Then “wow, he did a great job!” A big THANK YOU ! “ Texas RHC Manager (Used with her permission).

The Practice Analysis-Evaluation Report is the result of the comprehensive analysis Jim conducts while in your clinic for a portion of one day or two days. The total amount of time spent at the clinic depends on travel schedules, location of the clinic, and the total number of clinics being analyzed.

You receive the final printed report before Jim leaves the clinic.

While on-site, ample time is devoted to asking questions of the clinic manager and clinic staff, reviewing all areas of RHC operations, billing, etc. The resulting report contains much more than the minimum requirements for the Annual Evaluation Report. This report serves as a “checklist” for improving the clinic’s operations and reimbursements.

Practice Analysis-Evaluation Report Table of Contents

  • Service Area Defined
  • Annual Evaluation Committee
  • Annual Evaluation Process
  • Administrative Review:
  • Billing Review:
    • Nursing Home Billing
    • New UB04 Requirements
    • Use of modifiers
    • Non-RHC service billing
    • Practice-specific billing
    • MUCH more
  • Facility Inspection:
  • Policy & Procedures Manual Review Report
  • Emergency Preparedness Plan policies & procedures REVIEW
  • Appendix A: Medical Director Verification
  • Appendix B: Recommendations and Chart Review Report
  • Appendix C: Documents Needed When Surveyor Arrives
  • Appendix D: Preventive Services Billing Grid
  • Appendix E: Janitorial Services Checklist
  • Appendix F:   Nurse Duties Checklist
  • Appendix F: Emergency Preparedness (EOP) Checklist
  • Appendix H: DEA Controlled Substance Regs
  • Appendix I: Section 1557 (LEP) Regs

There is no need to close the clinic for any portion of the site-visit. This service includes a “mock” State Inspection, utilizing the same format State inspectors use, with major additions gathered over the years of experience in inspecting RHCs.

Ample time is devoted to meeting with clinic billing staff, providers and others deemed appropriate by clinic Administration. One result of this on-site consultation is the discovery of any area the clinic may be out of compliance with regulations and much more. The following benefits are often the results of having this Practice Analysis-Evaluation On-Site Consultation conducted by Healthcare Horizon:

  • Discovery of lost or non-billed reimbursements/claims
  • Discovery of improperly billed claims that could have resulted in penalties from CMS/Medicaid
  • Increased revenue due to corrected claims process
  • Discovery of facility issues that would have resulted in re-certification citations and possible loss of RHC status
  • Cost Report review results in changes to data collection, etc. and higher encounter rate
  • Recovery of revenues not know prior to the consultation
  • Corrected coding by providers
  • Risk Assessment results in avoiding potential law suits
  • Corrected Medical Records forms, etc. bringing the clinic into compliance with CMS requirements
  • Improved efficiency of staff
  • Improved knowledge of RHC requirements

Healthcare Horizon will provide a customized proposal, specific to your location and situation upon request. Fees vary depending on location, etc., and begin at $1,595.

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