Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians

Don Self and Assoc. Inc.
Don Self and Assoc. Inc.
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FREE DOCUMENTS 1-9 Including Medicare Fee Schedules

17000 & 17003 (JPG)Download
1995 DOCUMENTATION GUIDELINES (pdf)Download
1997 DOCUMENTATION GUIDELINESpdf (pdf)Download
2022 CMS LAB FEE SCHEDULE Q1 (xlsx)Download
99211 (ppt)Download
99239 REQUIRES MINUTES (pdf)Download
99483-COGNITIVE ASSESSMENT (pdf)Download

FREE DOCUMENTS - A

ABN BOOKLET FROM CMS (pdf)Download
ALLERGY SUPERBILL (pdf)Download
assignment-of-benefits (doc)Download
ASSIGNMENT OF BENEFITS - ANN MOLL (doc)Download
ASSIGNMENT OF BENEFITS FORM IN WORD (docx)Download
AUDIT SHEETS 4-IN-1 (pdf)Download
AUDIT TOOL USED BY MEDICARE (pdf)Download
AUDIT WORKSHEET - EMERGENCY ROOM (doc)Download
AUDIT WORKSHEET - EST PT (doc)Download
AUDIT WORKSHEET - NEW PT (doc)Download
AUDIT SHEET - NEURO - ORTHO (pdf)Download
AWV (pdf)Download
AWV FORM (pdf)Download
ALCOHOL MISUSE SCREENING (pdf)Download

FREE DOCUMENTS - B

BAA Incorporating Omnibus Rule Changes (docx)Download
Billing-Compliance-Manual (pdf)Download
BILLING PRODUCTIVITY LOG (doc)Download
BMI-table (pdf)Download

FREE DOCUMENTS - C

CALAD V CIGNA (pdf)Download
CARDIAC QUESTIONAIRE (doc)Download
CARDIO EST PROGRESS NOTE (pdf)Download
CARDIO NEW PT PROGRESS NOTE (pdf)Download
cardiology-derby (doc)Download
CARDIOLOGY SUPERBILL (doc)Download
CARE PLAN OVERSIGHT FORM1 (rtf)Download
CARE PLAN OVERSIGHT IN WORD (doc)Download
CHARITY POLICY APPLICATION (rtf)Download
Chiropractic Services 7-2018 (pdf)Download
CHIROPRACTIC SUPERBILL (doc)Download
CLINICAL DEMENTIA RATING WORKSHEET (PDF)Download
CMS-Office Listing (doc)Download
CO-PAY LETTER (doc)Download
CODE of CONDUCT EXAMPLE (doc)Download
Coding-Advisor-Platinum (mp4)Download
CODING AUDITING FORM (doc)Download
CODING CORRECTION CARD (pdf)Download
CODING FLOWCHART BY JEFF RESTUCIO (doc)Download
Coding-Advisor-Platinum (mp4)Download
COGNITIVE FOCUSED HISTORY FORM (docx)Download
Cognitive Screening Questions (pdf)Download
COLLECTION AGENCY CHECKLIST (doc)Download
COLLECTION LETTER - BALANCE DUE (rtf)Download
COLLECTION LETTER - COLLECTION PROCESS (doc)Download
COLLECTION LETTER - NO INS RESPONSE (rtf)Download
COLLECTION LETTER PAYMENT ARRANGEMENT (rtf)Download
COLLECTIONS - PATIENT ACCOUNT FLOW (ppt)Download
COLLECTIONS - PHYSICIAN NOTIFICATION (rtf)Download
COMPLIANCE OFFICER DESCRIPTION (doc)Download
COMPLIANCE PLAN - CPT CODING (txt)Download
COMPLIANCE PLAN FOR BILLING SERVICE (doc)Download
COMPLIANCE PLAN (txt)Download
Compliance-Action-Checklist (pdf)Download
CONSENT FORM - MIINORS (doc)Download
CONSENT FORM FOR TREATMENT (doc)Download
CONSENT FORM SPOOF (doc)Download
CONSULT REQUEST - PAIN OR NEURO (doc)Download
CONSULTATION REQUEST FORM (doc)Download
CONTRACT NEGOTIATION (pdf)Download
Coordination-of-Benefits (pdf)Download
COPAY - DEDUCTIBLE - WAIVER (doc)Download
Credentialing-Info (pdf)Download
CRITICAL CARE TEMPLATE - MICU (doc)Download
CRITICAL CARE TEMPLATE (doc)Download

FREE DOCUMENTS - D

DEATH PRONOUNCEMENT BILLING (doc)Download
DEPRESSION SCREENING MEDICARE GUIDELINES (pdf)Download
DERMATOLOGY SUPERBILL (pdf)Download
DIAGNOSIS POINTER - BLOCK 24E (pdf)Download
DIAGNOSTIC TEST INTERP RULES (pdf)Download
DISCHARGE FROM SNF - MEDICARE (pdf)Download
DIVORCE LETTER FOR PATIENTS (doc)Download
DIVORCE POEM FOR PATIENTS (doc)Download
DRUG DISPENSING GUIDELINES FROM GEORGE WARD (doc)Download
Depression Screening PHQ9 (pdf)Download

FREE DOCUMENTS - E

E&M AUDIT SHEET (doc)Download
E&M DOCUMENT TABLE (doc)Download
E&M GUIDELINES - 1995 (pdf)Download
E&M GUIDELINES - 1997 (pdf)Download
E&M HISTORY (doc)Download
E&M PROGRESS SHEET (doc)Download
Electrophysiology labsheet (pdf)Download
EMERGENCY ROOM SUPERBILL (pdf)Download
EMPLOYEE EVALUATION FORM - HOURLY (doc)Download
EMPLOYEE EVALUATION FORM (pdf)Download
EMPLOYEE PRE-EMPLOYMENT BILLING TEST (pdf)Download
EMPLOYEE PROSPETIVE QUIZ (doc)Download
EMPLOYEE REPRIMAND FORM (doc)Download
ENCOUNTER FORM - PROGRESS NOTE (doc)Download
ENCOUNTER FORM PROGRESS NOTE2 (doc)Download
ER AUDIT WORKSHEET (doc)Download
ER_ACUITY_SHEET (doc)Download
ERISA ASSIGNMENT OF BENEFITS (doc)Download
ERISA RECOUPMENT LETTER (pdf)Download
ERISA-LAW (pdf)Download
EVAL FORM FOR EMPLOYEES (doc)Download

FREE DOCUMENTS - F

FAMILY MEMBERS PER MEDICARE (doc)Download
FAMILY PRACTICE SUPERBILL - 2 (pdf)Download
FAMILY PRACTICE SUPERBILL (doc)Download
FLUOROSCOPY CODE APPEAL (doc)Download

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