Corporate Compliance

1. How to use audit forms as training tools
2. Clinical trials: 10 easy steps to assess your risk
3. Gov't audit insider

Healthcare Auditing Weekly, September 10, 2003



Health Care Auditing Strategies
NEW Newsletter 		Guide to Compliance Auditing: Applying OIG Techniques and Tools
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In This Week's Issue

  1. How to use audit forms as training tools
  2. Clinical trials: 10 easy steps to assess your risk
  3. Gov't audit insider
This Week's Headlines

1. How to use audit forms as training tools

Audit forms make great compliance training tools. They are helpful for explaining the evaluation and management (E&M) guidelines developed by the American Medial Association and the Centers for Medicare and Medicaid Services.

Take your audit forms and turn them into a training pad; resize them into a 3 x 5 pad or larger. Use a real-life medical record to illustrate how to audit an E&M visit or make up a humorous record.

For this training method to succeed, let your audience know that the trainer did not design the E&M rules. The audience may be surprised at the "counting methodology" in the E&M documentation rules, so start with a history about the rules and how they developed. Stress that E&M coding is about the complexity with which the patient presents to the physician; the higher the complexity, the higher the level of visit you may bill. View the documentation rules as a tool to help the physician to document the required components for the level to be billed, rather than as some punitive measure.

This method also works well when going over the information required on a UB-92 or a HCFA-1500. Resize the form and go over the fields and their descriptions on it. Identify the sources of the information and who supplied it.

This was adapted from the book "Ready, Set, Comply!" For more information on training employees and clinical staff on compliance issues, order the book "Ready, Set, Comply!" This book features games, quizzes, and emails for fun and easy compliance training. Click here for more information or to order.

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Health Care Auditing Strategies, the 12-page monthly newsletter, can help you get the most out of your audits. It offers practical how-to articles, sample policies and procedures, best practices, and auditing techniques for specific areas, including coding systems, billing systems, cost reports, credentialing processes, employee background checks, education and training programs, and quality of care.

For more information, including how you can save 10%, Click here or call 800/650-6787 and mention Source Code EN1614B.

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    Take advantage of these subscriber benefits, as well as auditing best practices and how-to articles by subscribing to Health Care Auditing Strategies. Save 10% by ordering online.

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    2. Pay-Per-View article: Clinical trials: 10 easy steps to assess your risk

    Auditing and monitoring clinical trials is a must for any organization that performs clinical research. Since human subjects participate in this research, it is critical to have systems in place to prevent errors and omissions, says Lisa Murtha, JD, vice president of audit and compliance at Children's Hospital of Philadelphia.

    The government is actively pursuing research organizations for compliance violations, says Murtha. The media are also spotlighting ethics concerns. With stakes this high, help your organization put a top-notch auditing and monitoring plan in place . . .

    To find out how to audit clinical trials, order the pay-per-view article "Clinical trials: 10 easy steps to assess your risk." The cost is $10. Subscribers to the online version of Health Care Auditing Strategies have free access to this article. Subscribers to the print edition can find it in their August issues.

    BETTER DEAL!
    Or for only $23 per month, you can get even more auditing best practices and how-to articles by subscribing to Health Care Auditing Strategies. Save 10% by ordering online.

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    Network with your audit colleagues

    "Audit Talk" is a new, moderated chat forum that members can use to post messages or questions for their peers 24-hours-a-day. "Audit Talk" offers a free forum to network, share ideas, and solve problems for those in the audit industry. Getting involved is easy. To subscribe, just send your request to this e-mail: owner-audit_talk@hcpro.com.

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    3. GOV'T AUDIT INSIDER

    Outlier payments

    The Office of Inspector General's (OIG) objective for this audit was to determine whether Rush-Presbyterian-St. Luke's Medical Center (Rush) was reimbursed properly for outlier payments made during the initial implementation of the Outpatient Prospective Payment System.

    The OIG took the following steps to meet its objective:

  • Obtained the Centers for Medicare and Medicaid Services' National Claims History (NCH) file and identified 2,166 Medicare outpatient claims with outlier payments, totaling $757,155, for services rendered from August 1, 2000 through June 30, 2001
  • Identified high-risk outlier claims, defined as claims having an outlier payment of at least 85% of the total claim payment
  • Selected a judgmental sample of 50 claims with outlier payments totaling $83,805
  • Discussed and learned about Rush's billing procedures for accumulating charges, creating outpatient bills, and submitting Medicare claims
  • Reviewed the medical files and discussed the medical necessity and reasonableness of the charges billed for selected claims

    To read the audit report "Review of Medicare Outpatient Prospective Payment System Outlier Payments made to rush-Presbyterian-St. Luke's Medical Center," click here.

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    "Strategies for Health Care Compliance," a 12-page monthly newsletter, helps you thrive in the ever-changing compliance environment by providing easy-to-understand compliance advice and analysis of the latest regulations. Each month, this newsletter offers how-to tips, features about your peers, policies and procedures, and tools for improving the efficiency and effectiveness of your corporate compliance programs. To learn more, click here or call 800/650-6787.

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