Healthcare Billing & Coding Compliance Checklist
Avoid claim denials & maximize revenue! Our Healthcare Billing & Coding Compliance Checklist ensures accuracy, minimizes risk, and keeps your practice audit-ready. Download now for streamlined processes and peace of mind.
This Template was installed 0 times.
Patient Demographics & Insurance Verification
Ensuring accurate patient information and insurance coverage before services are rendered.
Patient First Name
Patient Last Name
Patient Date of Birth
Patient Phone Number
Insurance Primary?
Insurance Provider Name
Insurance Member ID
Insurance Group Number
Procedure & Diagnosis Coding (ICD-10)
Verification of correct diagnosis codes based on medical documentation.
ICD-10 Code Primary Diagnosis
ICD-10 Code Secondary Diagnosis (if applicable)
Supporting Documentation Notes (e.g., physician documentation, lab results)
Number of Diagnoses Documented
Date of Diagnosis Documentation
Physician Signature (Verify)
Procedure Coding (CPT/HCPCS)
Ensuring proper coding of procedures performed, adhering to guidelines.
CPT/HCPCS Code
Procedure Description (from CPT/HCPCS)
Modifier Applied (if applicable)
Modifier Description (if 'Other' selected)
Units of Service
Service Date
Procedure Identifiers (e.g., Modality, Approach)
Modifier Application
Accurate use of modifiers to reflect specific circumstances of the service.
Modifier Applied (if any)
Modifier Justification (if applicable)
Modifier Percentage Adjustment (if applicable)
Applicable Billing Policy Adherence
Date of Modifier Review
Charge Entry and Documentation
Properly entering charges and verifying supporting documentation.
Total Charges Entered
Detailed Description of Services Rendered (for clarity)
Units of Service Billed
Date of Service
Biller Signature (Confirmation of Accuracy)
Charge Entry Method (Manual/Automated)
Claim Submission & Electronic Data Interchange (EDI)
Verification of claim format and adherence to EDI standards.
Claim Control Number
Transmission Method (e.g., Direct, Clearinghouse)
Number of Claims Submitted
Submission Date
EDI Format Version (e.g., 837 Professional)
Functional Acknowledgement (FA) Status Codes
Denial Management & Appeals
Tracking and addressing claim denials with appropriate appeals.
Date of Denial Received
Denial Code (from payer)
Payer's Reason for Denial (copy from denial letter)
Assigned to Appeals Reviewer
Appeal Submission Date
Documentation Submitted with Appeal (description)
Appeal Status
Notes/Comments on Appeal Outcome
Auditing & Compliance Reviews
Regular audits to ensure ongoing compliance with billing and coding regulations.
Audit Start Date
Audit End Date
Number of Claims Reviewed
Number of Coding Errors Found
Coding Guideline Areas Reviewed
Summary of Audit Findings
Auditor Signature
Overall Compliance Rating
Fraud and Abuse Prevention
Identifying and preventing fraudulent billing practices.
Describe any recent unusual billing patterns observed.
Has any employee been identified for potential training on fraud prevention?
Number of referrals received from a single referring physician in the last month:
Which of the following are potential red flags for fraud? (Select all that apply)
Date of last fraud risk assessment review
Reviewer Signature confirming fraud prevention protocols are in place
Staying Updated on Regulatory Changes
Maintaining awareness of current coding guidelines and regulatory updates.
Last Regulatory Update Review Date
Summary of Key Regulatory Changes
Source of Regulatory Information (e.g., CMS, AAPC, AHIMA)
Number of Continuing Education Credits Completed (Regulatory Updates)
Next Scheduled Regulatory Training Date
Healthcare Management Solution Screen Recording
See how ChecklistGuro's healthcare management solution can improve your workflows and improve patient care! This screen recording showcases key features like: patient onboarding, task assignment, reporting. Learn how our BPM platform helps healthcare providers optimize operations and reduce administrative burden. #healthcare #healthcaremanagement #bpm #checklistguro #patientsafety #automation
Related Checklist Templates
Healthcare Patient Portal Access Checklist: Security & Usability
Healthcare Data Breach Response Checklist: Notification & Remediation
Healthcare Cybersecurity Incident Response Checklist
Healthcare IT Security Checklist: Data Protection & Access Control
Healthcare Disaster Recovery Checklist: Business Continuity & Resilience
Healthcare Audit Preparation Checklist: Readiness & Documentation
Healthcare Business Associate Agreement Checklist: HIPAA Compliance
Healthcare Vendor Management Checklist: Risk & Compliance
Healthcare Patient Experience Checklist: Satisfaction & Feedback
Healthcare Value Analysis Checklist: Cost Savings & Standardization
We can do it Together
Need help with Checklists?
Have a question? We're here to help. Please submit your inquiry, and we'll respond promptly.