OFFICE – TM Clinical Practice POLICIES & PROCEDURES Manual.

Description

Downloadable and customizable templates of OFFICE Documentation, Policies, and Procedures for your practice.

Office Policies & Procedures Manual

• Office opening and closing procedure ……………………………………………………………………………………… 2
• Patient information policy …………………………………………………………………………………………………….. 4
• Patient scheduling procedure ……………………………………………………………………………………..…….… 5
• Emergency services policy & procedure …………………………………………….……………………………………… 7
• Patient communication policy and procedure ……………………………………………………………………………… 8
• Insurance verification procedure ……………………………………………………………….……………………….… 10
• Patient check-in procedure …………………………………………………………………………….………………….. 12
• Usual and customary fee list & discounts policy …………………………………………………………………………. 15
• Patient payment policies ………………………………………………………………………………………..………….. 17
• Patient check-out procedure ……………………………………………………………………………………….………. 19
• Cancellation policy and procedure …………………………………………………………………………………..…….. 21
• No-show policy and procedure …………………………………………………………………………………..…………. 23
• Patient consent policies and procedures ………………………………………………………………………………….. 25
• Patient records request policy and procedure ………………………………………………………………..………….. 27
• Accepted insurance plans policy …………………………………………………………..…….………………….…….. 29
• Superbill submitting to the insurance biller procedures ………………………………………………………..……….. 30
• Insurance payment reconciliation …………………………………………………………………………………………. 31
• Rejected claims resubmission procedure ………………………………………………………………………..………. 33
• Equipment inspection procedure ………………………………………………………………………………………….. 35
• Patient complaints & concerns procedure ………………………………………………………………………………… 37
• Policy and procedure for managing patients who are non-compliant with healthcare advice ………………………. 39
• Acupuncture standard episode of care flow procedure ………………………………..………………………………… 42
• TCHM standard episode of care flow procedure ………………………………………………………………………… 45
• Inventory ordering, storage & expiration inspection procedure ……………………………………………….……….. 47
• TCHM compounding & dispensing policy and procedure ……………………………………………………………….. 50
• Adverse events tracking, responding, and reporting procedure ……………………………………………………….. 52
• Workforce training plan ……………………………….…………………………………………………………………….. 56

Office Manual Templates – Patient Care

1. Acupuncture Council Informed Consent ….. 1
2. Acupuncture Council Arbitration Agreement …… 2
3. Acupuncture Council Informed Consent for In-Person Services During Covid-19 Public Health Crisis ….. 3
4. Informed Consent and Liability Waiver, Including TCHM & Telehealth ….. 5
5. Patient Consent Regarding Diagnostic Exam …. 7
6. Consent for Use and Disclosure of Reproductive Health Information …… 8
7. Informed Consent for Facial Acupuncture Treatment: Acupuncture Council ……. 9
8. Authorization for Disclosure of Health Information ….. 11
9. Authorization for Release of Medical Records …… 12
10. Restriction of Use or Disclosure of Protected Health Information ….. 13
11. Consent to Leave Voice or Text Messages …… 14
12. Patient Consent for Medical Photography …… 15
13. Social Media Informed Consent ….. 16
14. Notice of Privacy Practices …… 17
15. Patient Insurance Information Form …… 20
16. INSURANCE Payment Policy & Assignment of Benefits ….. 21
17. CASH Payment Policy ….. 23
18. Credit/Debit Card Pre-Authorization Form ….. 24
19. Good Faith Estimates ….. 25
20. OFFICE Use – Insurance Verification Form ….. 27
21. Advance Beneficiary Notice of Non-coverage (ABN) …….. 28
22. GA Modifier Consent Form (Advance Beneficiary Notice (ABN) ……. 29
23. Medical Record Amendment/Correction Request …… 30
24. Letter to Patients Who Cancel or Fail to Keep Appointments …… 31
25. Letter to Patients Who Fail to Follow Up on Labs/Tests …… 32
26. Clinic Practices Complaint Form …… 33
27. Acupuncture Adverse Event Incident Report ……. 34
28. TCHM Adverse Event Incident Report ……. 35
29. TCHM AE Identification, reporting & Causality Assessment Form…… 36
30. Office Copy – TCHM – Compounded IN-Office …… 39
31. Label Custom TCHM – Office Dispensed – Patient Copy …… 40
32. Raw/Crud TCHM Cooking Directions Handout …….41

Office Manual Templates – Administrative Documents

1. Letter of Denial Appeal ……. 1
2. Facsimile Cover Sheet …… 2
3. Disclosures of Patient Information Log ….. 3
4. Dispensary Training Log …… 4
5. Equipment Inspection Log …… 5
6. Office Supply Ordering Form …… 6
7. Inventory Ordering, Form …… 7
8. Inventory Ordering, Storage & Expiration Inspection Log …… 8