Compliance Audits

It is the process of assessing historical & current claims and ensuring that claims are submitted in compliance with Local and National Coverage Determinations and payer-specific guidelines(LCD).

There are four main phases of the entire compliance audit cycle. They are Preparation, Performance, Reporting & Follow-up.

Encryption of emails protects the contents of the email and the content of the attachments when it reaches unintended recipients. We mandate emails to be encrypted and passwords to be protected in our organization as increased security and compliance measures.

It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and establishes trends of potential billing and/or coding problems. This report can be utilized for account analysis as well.

Education, feedback and more education. You must be persistent and follow through to show your commitment. We audit doctor’s medical records and any inconsistency is taken as an education source to educate physicians.

You can use the ROS, past medical, social & family history. The provider’s documentation should support that they reviewed the ROS and PFSH documented by the ancillary staff. The history of present illness needs to be taken and documented by the physician.

Employees working in various healthcare roles, including coding and billing, should be trained in appropriate areas (HIPAA, HITECH, etc.) immediately upon hire and at least annually thereafter. Employees should be trained when existing regulations change or are updated and when new regulations are put into place. Our experienced training team ensures this is being followed to all our employees on board.

Resources that included for references are: OIG, the Centers for Medicare & Medicaid Services, the U.S. Department of Health & Human Services, and AAPC. These organizations provide informational articles, auditing software, news about updates and alerts, compliance ideas, and more.