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Appendix E INFORMAL CHECKLIST HOSPITAL NAME . NUMBER INFORMAL CHECKLIST OF ITEMS TO DESCRIBE THE FLOW OF CLAIMS INFORMATION FROM THE MEDICAL RECORD DEPARTMENT TO THE BILLING DEPARTlENT TO THE FISCAL INTER- MEDIARY (~11 responses should refer to calendar year 1974) 1. On the average how many days after discharge was information con diagnosis transmitted to the billing office for insertion on the Medicare claim form during 1974? 2. How many days after discharge was the medical record completed and a final diagnos ~ s determined ? When more definitive dsagnos tic ~nfc'~matson became available which dif- fered from that previously submitted to the bills ng office, was that $n- formation forwarded to the billing office? 4. Did the bill, ng office forward up-dated diagnostic informal' on to the fiscal intermediary?_ S. In what physical form was information on diagnoses and procedures trans- mitted to the billy ng office? Admit ~ sag shee t Xerox of face sheet Ent ire record Discharge list: hand-wrst ten computerized Other typed 6. If portions of the medical record were transmitted, what was the training of the person in the billy ng 'office who determ: ned the diagnoses that should be entered on the Medicare claim form? 7. If a discharge list or some ether summary of abstracted information was for- warded to the billing office, by whom was the diagnostic information ob- tasnet and from what source? 8. Did the diagnostic information forwarded to the billing office contain codes narratives, car both? 9. If the reformat son was coded, how was it translated back to a narrative form for submission to fiscal intermediary? 10. What definition cuff principal diagnosis was used by the hospital in com Deleting Medicare claims forms during 1976? 105
106 Appendix E 11. What definition of principal procedure was used by the hospital In complet sng Medicare claims forms? (Please note whether physical therapy or other non-surg~cal procedures were secluded on the Medicare claims form. ) 12. Did the billing office provide the intermediary with more than one diagnosis? 13. Did the belling of fice provide the intermediary we th more than one procedure? 14. Total number of Medicare discharges from this hospital ~ n 1974.
