Sample Form for Medical Chart Audit

					Structure                                                Process                                                        Outcomes
Sample Business Planning Template
                                              Priority                                        Responsible     Target
Topics and Categories                         1/2/3      Process/Action Steps                 Individual(s)   Date(s)   Comments/Progress/Dates   Completed
A. Administrative/Structure
.

1. Organizational Structure
2. Job Descriptions
3. Hospital or Physician Based Practice
4. Tax ID number (Hospital or Physician)
5. Practice Management Structure
6. Practice Operations (P&Ps)
7. Policies & Procedures (HR)
8. Billing System
9. Medical Records
10. Scheduling Templates
11. Encounter Form Development
12. Copay & Referral Process Protocols
13. Equipment & Supplies (Medical & Office)
14. Telecom System
15. I.S. System
16. Medical Staff & Payer Credentialing
17. Cost Center & Budget Forecasting
18. Physical Space Requirements/Floor Plans
19. Fee Schedules Review
20. Phone Coverage Protocols
21. Volume Projections
22. ABN Process
23. Budget Variance Process
24. Claim Denial Meeting
25. Monthly Staff Meeting Schedule
26. Staff Orientation
27. Chargemaster Setup
28. Physician & Clinical Staff Recruitment
29. No-Show & Cancellation Protocols
30. Vendor Relationships




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Structure                                                        Process                                                        Outcomes
Sample Business Planning Template
                                                      Priority                                        Responsible     Target
Topics and Categories                                 1/2/3      Process/Action Steps                 Individual(s)   Date(s)   Comments/Progress/Dates   Completed



B. Clinical
1. Clinical Policies & Guidelines
2. Inpatient/Outpatient Coverage
3. Clinical Staffing Analysis
4. CQI Project Planning
5. Patient Satisfaction Survey Tools
6. Physician Satisfaction Survey Tools
7. Physician NCQA Provider Recognition
8. Educator Chart Audit Process
9. Charting Protocols (Physicians & Educators)
10. Process for Analysis of CQI results
11. Medication Charting & Review Process
12. Medical Staff Credentialing
13. NP Collaboration Agreements in Place
14. Insulin Protocols (Inpatient & Outpatient)
15. Referral Protocols for Co-Morbidities
16. Referral Protocols for Exercise & Mental Health
17. Pump Protocols/CGM
18. Pediatric Protocols
19. Gestational Protocols/Pregnancy
20. Aging Adult
21. Pre-Diabetes Protocols
22. Clinical Staff Orientation
23. Physician & NP Productivity Metrics




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Structure                                                     Process                                                        Outcomes
Sample Business Planning Template
                                                   Priority                                        Responsible     Target
Topics and Categories                              1/2/3      Process/Action Steps                 Individual(s)   Date(s)   Comments/Progress/Dates   Completed
C. Education
1. Annual Plan in Place/Revised Annually
2. Patient Forms Development
3. Approval by Forms Committee
4. Curriculum: Individual & Group Class
5. ADA Program Recognition/Renewal
6. CDE Credentialing/Training for CDE Exam
6. Active Education Advising Committee
7. Educator Schedule Templates(RN & RD)
9. Productivity Metric Review
10.Outcomes Measurements Summarized
11.CQI Projects in Place

D. Marketing

1. Establish Comprehensive Marketing Plan
2. Develop Website Content
3. Advertising Schedule
4. Develop Marketing Brochures & Patient Packets
5. Grand Opening Planning for Affiliate
6. Community Outreach Scheduling
7. Establish Marketing Monthly Calendar
8. Work with Community Benefits Staff
9. Print/Radio/TV Planning
10 Work with Physician Relations Staff
11.Schedule Grand Rounds
12.Schedule Professional Education Program Plan
13.Develop Referring Physician Outreach Plan
14.Marketing Plan for Internal Practices
15 Identify Target Populations
17.Develop Outcome Measurements




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Description: Sample Form for Medical Chart Audit document sample