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Audit your top compliance risk areas

Healthcare Auditing Weekly, November 18, 2003

Use a "finders and fixers" plan to review and correct your organization's biggest compliance issues. After performing your audit, help staff members identify their problem areas, then show each worker how you uncovered them and how they can prevent them. The list below is a starting point for some of the key areas to audit internally:

·  All areas of risk as identified in the Office of Inspector General (OIG) work plan

·  The UB-92 and chargemaster for new codes, old codes, and deleted codes

·  Review your denial management process-are back-end fixes being made

·  Review billing of pass-though items, especially from 2001 to 2002

·  Review units of service reporting, especially for drugs; determine whether rebilling opportunities exist

·  Review the charge capture process in the emergency department, as well as other departments

·  Audit modifier usage, especially -25, -52, 59, 72, and 74

·  Check evaluation and management guidelines created and the distribution of code levels

For more on analyzing your outlier exposure, order the book "Compliance Troubleshooter: Tackling the Top 10 Compliance Challenges." This book features information on The False Claims Act, outlier payments, quality of care, economic and traditional economic credentialing criteria, EMTALA, nonphysician practitioners, billing and documentation, outpatient prospective payment system, Stark, and inpatient compliance issues. Click here for more information or to order.

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