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Choose the right outside help for your next compliance audit

HIM Connection, April 20, 2004

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If your organization has decided to hire an outside firm to perform a compliance audit, create criteria to select a firm that fits your needs. Your organization's entire compliance committee should be involved in determining the criteria, as well as in selecting the firm.

You can ask potential firms the following sample questions:

1. Does your firm have past experience auditing any of the following?

• All billing functions
• All coding functions
• Medical record documentation content and quality
• Medical record documentation completeness
• Release of information (ROI)
• Record storage and retention 
• Other areas

2. What are the credentials of staff performing these functions?

• Registered health information administrator (RHIA)
• Registered health information technician (RHIT)
• Certified coding specialist (CCS)
• Certified coding specialist-physician based (CCS-P)
• Certified professional coder (CPC)
• Certified professional coder-hospital (CPC-H)
• Any other credentials

3. Are the individuals performing the functions employees of the firm?

4. Has the firm ever charged a contingency fee to audit any of the above functions? If so, eliminate the firm as a possibility.

5. Does the firm use computerized tools to select samples, store data, and generate reports?

6. What specific compliance resources does the firm have?

•  Former compliance officers on staff
• Attorneys with criminal defense experience on staff
• Attorneys with a healthcare background on staff
• Other

7. What kind of follow-up services can the firm provide if deficiencies are identified?

• Coder education 
• Physician education
• Nurse education
• Ancillary-provider education
• Coder documentation
• Physician documentation
• Nurse documentation
• Ancillary-provider documentation
• Writing and coding policies and procedures
• Any other services

8. How do you address the issue of providing audit services to a healthcare provider when you also provide them with some other type of ongoing work (e.g. ROI)? Do you have a separate audit group?

A savvy organization values the compliance audit, and seeks a firm with noted expertise in compliance auditing to record results for any third parties to view. The question that your organization needs to address-knowing the significance of the compliance process-is, "Can we afford not to retain an outside firm to perform compliance audits?"

This week's excerpt is from the book, "Seven steps to HIM compliance," by Ruthann Russo, JD, RHIT. Find this, and other helpful forms for HIM directors, with the new book, "50 Forms for HIM Directors," a compilation of sample forms our expert-readers have sent us over the years. Click here to order or learn more, or check out our Editor's Choice below for more information.

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