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Scenario Red Flag - Assessment
Red Flag:
Description:
Path:
Provider Compliance - Submission of Accurate Claims and Information > Billing - Patient not present > Billing for services not provided - Using phantom or deceased persons' names
Red Flag Assessment
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edit
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1.
Assessment Performed By
2.
Assessment Date
3.
Red Flag Frequency
Frequent
Moderate
Infrequent
4.
Red Flag Risk
High
Moderate
Low
Red Flag Evaluation
Audit Procedure Results
Procedure
Procedure Description
Red Flag Frequency
Red Flag Risk
Risk Narrative
Perform review of selected patient files
Moderate
Moderate
Test Results
Test
Test Description
Red Flags Frequency
Red Flags Risk
Risk Narrative
Test patient files
Test
Moderate
Moderate
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