An annual evaluation or program evaluation is one of the eight required conditions of participation that all rural health clinics must meet. Healthcare Business Specialists can assist you in completing this process. This is from the Rural Health Clinic Interpretive Guidelines: "An evaluation of a clinic's total operation including the overall organization, administration, policies andprocedures covering personnel, fiscal and patient care areas must be done at least annually. This evaluation may be done by the clinic, the group of professional personnel required under 42 CFR 491.9(b)(2), or through arrangement with other appropriate professionals."
We will come onsite and conduct a mock inspection of the facility, review the policy and procedure manual and supporting documentation that the clinic is following policy, review open and closed medical charts in compliance with the regulations, and issue a comprehensive report regarding the results of the annual evaluation. Additionally, we will review clinic utilization, CPT Code Frequency, Denials, EOBs, and chargemasters to determine if the clinic is charging, billing, and collecting the proper amounts from patients, insurance, Medicare and Medicaid.
The annual evaluation can be accomplished in about a 1/2 day of onsite time, and we will present any findings at a meeting at the clinic with a complete annual evaluation report. This process will eliminate receiving a condition level deficiency when the State inspectors arrive and will help you to evaluate the adequacy of billing processes. As part of the reporting, we will compare your expenses to benchmarks of other rural health clinics in our database of rural health clinic cost reports. This report will help you to determine how efficient your clinic is operating in comparison to other rural health clinics. If you would like to view a sample report, follow the link:
Just email us at firstname.lastname@example.org or call us at (423) 243-6185 to get us started.