1. ASTOCKAMP
Stockamp & Associates, Inc. (Stockamp)
Revenue Cycle Solution at (Hospital)
Foliow-Up Quality Review Form
& associates
Representative: LaTonya Broadus
Reviewed by: Leticia
Account Number
Patient Name
HIS Updated .07 .07 .06
Account in Correct Phase
Account in Correct Insurance Coverage
Appropriate Rebill/Claim Force
Correct Action Taken (half points possible)
Self Pay/Patient Involvement .40
Additional Documentation Required.30
Appeals Handled Appropriately.30
Correct Transfers (if applicable).30
Account Resolved .30
Elevated if Necessary .40
Documentation Standards Met
Claim/Account Status .10
Action Taken .10
Contact Name and Number .15
Payment Information.15
Tickle Timeframe
Activity Code
Overall Evaluation (of possible 3.0)
Comments:
l)Good Note
Review Date:
Accounts From:
7/1/2014
7/11/2014
1 2 3 ... 4 5
205725630 205063103 204838759 205666351 205682778
Flavin Adam Dickinson Brown Burke
0
0.20 0.20 0.20 0.20 0.13
2.0 2.0 2.0 2.0 2.0
0.50 0.50 0.50 0.50 0.50
0.20 0.20 0.20 0.20 0.20
0.10 0.10 0.10 0.10 0.10
3.00 3.00 3.00 3.00 2.93
2) Good Note
3) Good Note
4) notes 07/8/14 great
5)not a corrected claim
Overall Evaluation
Meets or Exceeds Expectations (3.0-2.8)
Requires Minor Improvement (2.79 - 2.5)
Requires Major Improvement (2.49 - 0)
Representative:
Overall Score
h«. j(j
*-
L 2.99 ] Reviewer:
(Average of 5 Scores)
LG
CONFIDENTIAL
© 1995-2008, Stockamp & Associates, Inc. (Stockamp)
PLEASE SEE LIMITATIONS AND RESTRICTIONS
DESCRIBED ON THE LEGAL NOTICE PAGE OF THIS DOCUMENT
PROPRIETARY
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CCMC Follow-up QR Form 2011 ()
Last Printed: 7/31/2014 2:07 PM