Corporate Compliance

Tip: Create a mission statement for your audit

Healthcare Auditing Weekly, November 18, 2008

Every audit must begin with a clearly stated purpose that drives and defines the entire process. Create this purpose by following these steps:
  1. Determine whether the audit will be internal or external
  2. Define the audit’s purpose
  3. Define the audit’s population
  4. Select a sample
  5. Review quality assurance and abstract records
  6. Generate law data rights
  7. Analyze data
  8. Prepare a report
  9. Present the audit results
For example, the statement of purpose for a billing and coding audit should state, “This audit is being performed to identify any coding errors, particularly those which result in reimbursement errors. The goal of the audit is to improve the coding and billing process so that all reimbursement to the hospital is correct.” Also, consider addressing the following additional point in your purpose statement:
  • Are we focusing on identifying all coding errors, or just those that affect reimbursement?
  • In the course of the audit, are we going to identify documentation problems?
  • Are we looking to attribute errors to a specific individual, if possible?
  • Do we want to be able to extrapolate our findings to the entire universe of claims?
  • Do we want to concentrate on OIG focus areas?
  • Do we have a benchmarking process that we want to tie into the audit process?
This tip is adapted from The Compliance Officer’s Handbook. For more information about the book or to order your copy, visit HCMarketplace.

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