ADMINISTRATIVE SITE VISIT CHART/ CHARGES REVIEW The organization should pull 5 recent client charts. CDPHE staff will review what services were received, confirm the income code and then ensure the sliding fee scale was correctly applied to the visit (either by hand or in an electronic health record). WHERE IS WAS WERE WERE Comments CHART INCOME CLIENT CHARGES CHARGES, # CODE ASSIGNED FOR COLLECTIONS, (icare RECORDED? THE SERVICES BALANCE #) IS IT CORRECT COMPLETE DUE, & CURRENT? INCOME & DONATIONS CODE? ACCURATE? DOCUMENTED AND RECORDED? 1 2 3 4 5
ADMINISTRATIVE SITE VISIT CHART/ CHARGES REVIEW The organization should pull 5 recent client charts. CDPHE staff will review what services were received, confirm the income code and then ensure the sliding fee scale was correctly applied to the visit (either by hand or in an electronic health record). CHART # (icare #) WHERE IS INCOME CODE RECORDED? IS IT CURRENT? WAS CLIENT ASSIGNED THE CORRECT INCOME CODE? WERE CHARGES FOR SERVICES COMPLETE & ACCURATE? WERE CHARGES, COLLECTIONS, BALANCE DUE, & DONATIONS DOCUMENTED AND RECORDED? Comments 1 2 3 4 5
PSD_titleX2_SAMPLE-ONLY-Adminstrative-Day-Of-Visit-site-visit-tool-Update-2014.docx