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Arbitration Self-Evaluation Tool

Directions:

1. Choose 2-4 day sheets (sign-in or appointment logs) from the previous 60 days.
2. Pull the patient medical records from the first 10 patients seen each day. (These are patients seen in your office, not in a hospital or other setting.)
3. Check each medical record for an Arbitration Agreement. If an Agreement is present, continue across the Arbitration Self-Evaluation Tool, checking for the presence/correct completion of each item on the Agreement. Confirm the presence of the required item with a in the appropriate box on the Self-Evaluation Tool.
4. Continue following instructions #2 and #3 above until 25 medical records have been reviewed, not until 25 Arbitration Agreements have been found.
5. Calculate the percentage of agreements completed correctly:
• Count the number of medical records that have all boxes checked.
• Divide that number by 25 to get percentage of Arbitration Agreements completed correctly.

Example: 20 (medical records with all boxes checked) divided by 25 (total records reviewed) = 80% of Arbitration Agreements revewed are completed correctly.

Click here to view the Self Evaluation Tool

Download Toolkit and Instructions in Microsoft Word (.doc) format (zipped, 7KB)