Practice self-assessment checklist - Billing Assurance Toolkit

Helps you to identify your practice’s strengths and areas for improvement in its Medicare assurance approach.

Page last updated: 28 January 2016

Use the following checklist to review your practice’s Medicare billing assurance approach and identify areas for improvement. The checklist comprises a series of questions. It describes elements of a Medicare billing assurance approach below each question and also gives advice on how you could improve the accuracy of your practice’s Medicare billing.

The responses to this checklist are for your practice’s internal use only and do not need to be disclosed to the department. Review all boxes that apply to your practice’s current position. You can tick more than one box per question.

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.

The checklist can be completed by your designated Medicare billing assurance person. Alternatively, you can encourage all the health professionals in your practice to complete the checklist and collect responses to provide a whole-of-practice perspective on your practice’s Medicare billing assurance approach.

Question 1: Does your practice have a positive compliance culture?

Consider whether your practice:
    • has communicated the importance of compliance to all of its health professionals
    • has a clear set of Medicare billing compliance values and responsibilities
    • has a culture that encourages participation and the reporting of Medicare billing compliance concerns

Question 2: Does your practice have a designated person or persons whose role includes managing Medicare billing assurance?

Consider whether your practice has a person/s whose role is to:
    • regularly review your Medicare billing assurance approach
    • organise training on your Medicare billing assurance approach
    • organise regular training on the use of the Medicare Benefits Schedule (MBS), including updates to item numbers
    • be the central point of contact for Medicare billing compliance issues
    • escalate Medicare billing compliance concerns to senior management

Question 3: Does your practice have a Medicare billing assurance approach?

Consider whether your practice has documented policies and procedures (available online or in hard-copy format) that:
    • explain the Medicare billing assurance role and responsibilities of senior management
    • explain the Medicare billing assurance role and responsibilities of health professionals in your practice
    • explain the role of the designated Medicare billing assurance person or people
    • alert health professionals in your practice to the consequences of incorrect Medicare billing or non-compliance
    • direct health professionals in your practice to authorised Medicare education resources
      (Refer to Attachment A of this Toolkit for a list of authorised Medicare resources health professionals can use to identify, investigate, address and prevent Medicare billing assurance issues)
    • inform health professionals in your practice about how to report Medicare billing compliance concerns, and who to report them to
    • encourage health professionals in your practice to undertake Medicare education activities
    • allow enough time and resources for health professionals in your practice to undertake Medicare learning activities

Question 4: Do the health professionals in your practice have a good understanding of your practice’s Medicare billing assurance approach?

Consider whether the health professionals in your practice have been informed about:
    • the importance and operation of your practice’s Medicare billing assurance approach
    • their Medicare billing compliance role and responsibilities

Question 5: Does your practice have clear communication channels for reporting Medicare billing assurance issues?

Consider whether:
    • all health professionals in your practice are aware of who to contact for Medicare billing issues
    • your practice’s designated Medicare billing assurance person is easy to contact and usually available

Question 6: Does your practice have strategies in place to address possible incorrect billing under Medicare?

Consider whether your practice has strategies in place to:
    • regularly review its Medicare billing activity
    • enable your practitioners to regularly review their Medicare billing practices
    • assess and identify incorrect Medicare billing or possible non-compliance in a timely manner
    • facilitate voluntary acknowledgements or other notification procedures (where applicable) when incorrect billing has occurred
    • repay Medicare benefits that were paid as a result of incorrect claims
    • provide opportunities for health professionals to share and learn from the outcomes of Medicare billing assurance reviews
    • identify and communicate to health professionals Medicare billing assurance risks that have been identified and how to prevent those risks from re-occurring

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