Sustainability Resources

Resources and reference material for community agencies seeking to expand their service delivery model.

Building Your Internal Billing Infrastructure

• Credentialing/Recredentialing Checklist – Licensed Independent Practitioners (PDF)
  Checklist from HRSA’s Bureau of Primary Health Care.

The Medical Billing Process

• Creating Job Descriptions
  Guide from the American Academy of Pediatrics “Managing the Practice” series.
• Job Description Template for Billing Manager
  From the American Academy of Pediatrics “Managing the Practice” series.

Corporate Compliance

• Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians
  The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services provides educational materials to assist in teaching physicians about the Federal laws designed to protect the Medicare and Medicaid programs and program beneficiaries from fraud, waste, and abuse. (Download PDF)
• Compliance Program Guidance for Medicare+Choice Organizations
  OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements. (Download PDF)
• Summary of the HIPAA Privacy Rule
  This is a summary of key elements of the Privacy Rule including who is covered, what information is protected, and how protected health information can be used and disclosed.  From HHS. (Download PDF)
• Sample Auditing Compliance Plan (PDF)
  Sample document outlining components of an auditing compliance plan.
• All About OSHA
  Background materials on the Occupational Safety and Health Administration. (Download PDF)
• Clinical Laboratory Improvement Amendments (CLIA)
  The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations include federal standards applicable to all U.S. facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. CDC, in partnership with CMS and FDA, supports the CLIA program and clinical laboratory quality. (Download PDF)

Revenue Cycle Quality Assurance

• Practice Management Toolkit Financial Key Performance Indicators
  This toolkit from the American College of Physicians contains a series of spreadsheets intended to give the owner physician or office manager templates for monitoring key financial indicators within the practice.
• National Correct Coding Initiative (NCCI) Tool
  The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. This site has downloadable tools and instructions for Medicare providers. (Download PDF)

Specific Billing Areas: Telehealth

• Medicare and Telemedicine (or Telehealth)
  Article from the Center for Medicare Advocacy describing telehealth service coverage under Medicare.
• Telehealth Billing Compliance: Medicare Says Goodbye to the GT Modifier​
  Article from Telemedicine Magazine describing recent changes in coding rules. (Download PDF)
• Telehealth Services
  This booklet includes an overview of Medicare telehealth services for CY 2018, including a reference chart of billing codes. From CMS’s Medicare Learning Network.

Specific Billing Areas: Behavioral Health

• CPT Codes for Behavioral Health Services
  American Academy of Pediatrics. AAP News. 10/2/2017.