Tip: Conduct regular, focused audits
Healthcare Auditing Weekly, December 9, 2008
The OIG recommends that hospitals conduct regular audits. Either internal or external auditors with expertise in government healthcare requirements can conduct these audits. The audits should review external relationships with third-party contractors, specifically those with substantive exposure to government enforcement actions. At a minimum, audits should be designed to address the hospital’s compliance with laws governing the following areas:
- Kickback arrangements
- Physician self-referrals
- CPT, HCPCS, and ICD-9-CM coding
- Claim development and submission
- Reimbursement
- Cost reporting
- Marketing
In addition, the audits and reviews should cover the hospital’s compliance with rules and policies that have been the focus of government attention.
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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