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Tip: Reviewing your auditing and monitoring functions

Compliance Monitor, June 11, 2008

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The OIG recommends considering the following questions when reviewing the effectiveness of hospital auditing and monitoring:

• Is the audit plan reevaluated annually?
• Does it address the proper areas of concern, such as the findings from the previous years’ audits, risk areas identified as part of the annual risk assessment, and high-volume service?
• Does the audit plan include an assessment of billing systems in addition to claims accuracy?
• Is the role of the auditors clearly established?
• Are coding and audit personnel independent and qualified with the requisite certifications?
• Is the audit department available to conduct unscheduled reviews?
• Does a mechanism exist that allows the compliance department to request additional audits or monitoring should the need arise?
• Has the hospital evaluated the error rate identified in the annual audits?
• If the error rates are not decreasing, has the hospital conducted a further investigation into other aspects of the hospital compliance program to determine hidden weakneeses and deficiencies?
• Does the audit include a review of all billing documentation, including clinical documentation, in support of the claim?.

This tip was adapted from the Compliance Program Effectiveness Handbook. For more information about the book or to order your cop , visit HCMarketplace

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