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Health Care Auditing Strategies

Issue 7, July 10, 2003

• Enforce policies using audit logs, more policies

  One of the required implementation specifications under the final security rule's security...

Issue 12, December 1, 2003 - VIEW THE FULL ISSUE

• Hospital pharmacies: Four ways to meet your audit objectives

  Pharmacies represent one of hospitals' largest sources of both revenue and expense. This makes...

• How to start an IT audit group

  Nearly all data that your organization audits has passed through some sort of technology. Expand...

• Third party claims: Audit self-insured health benefit plans

  As insurance premiums skyrocket, many employers are choosing to self-insure their organization's...

• Graduate medical education

  Audit the accuracy of the resident full time equivalent (FTE) counts your hospital uses for...

Issue 11, November 11, 2003 - VIEW THE FULL ISSUE

• Audit the charge capture process

  Auditing your organization's charge capture process can help you increase profitability and enhance...

• Strategies for measuring privacy compliance effectiveness

  Measuring privacy program effectiveness has many benefits-it will help your organization focus...

• Follow the government's lead for this year's audits

  Help is here for organizations still debating which areas to audit in 2004. The Office of Inspector...

• Sample audit program for your organization's research costs

  Your organization must ensure that it excludes research costs above the usual patient care from the...

• Guidelines for measuring compliance effectiveness

  Focus on the following questions when auditing for compliance program effectiveness:

Issue 10, October 1, 2003 - VIEW THE FULL ISSUE

• Perform shadow audits to analyze your risk for outlier overpayments

  Your hospital may still have precious time to review its outlier claims before the government does...

• These ABCs spell out methods of responding to Medicare audit letters

  How you respond to a Medicare audit request is crucial: It's your first chance to get government...

• Physician practice: Market analysis is the key to contracting with managed care

  Managed care contracting can be like maneuvering through a dark room. Auditors need to guide their...

• Case study: How to perform mammography audits

  Mammography has become the most regulated and stringently controlled radiology modality. This is...

• Internal investigations: How to interview employees

  Handle employee interviews delicately when holding an internal investigation. The people who do it...

• Payroll audits

  Audit objectives: To evaluate the internal and business environment surrounding payroll to ensure...

Issue 9, September 1, 2003 - VIEW THE FULL ISSUE

• Prepare your chargemaster for government claims scrutiny

  The charge description master (CDM) drives an organization's reimbursement. Failing to maintain and...

• Laboratory audits: How to test for common billing and coding errors

  Audit your laboratory billing to identify any problem areas, says Christine Anusbigian, MBA, MT...

• Audit compliance hotline effectiveness

  Hotlines, or other comparable mechanisms for securing concerns, are essential to compliance. If...

• Ensuring a meticulous registration process is the key to accurate billing and re

  To determine the efficiency and accuracy of your registration function, perform an audit that looks...

• Sample selection form

  Download this sample selection form that you can modify to use at your own facility.

Issue 8, August 1, 2003 - VIEW THE FULL ISSUE

• Billing: The ins and outs of auditing observation services

  Most people misunderstand observation services and bill for then inappropriately, says Marianne...

• Fraud settlement prompted facility to add more audits and reviews

  It was 2001, and four medical schools in the University of California (UC) Health System settled...

• Rehab: Marketing audits help find hidden money

  A marketing audit allows rehabilitation providers to maximize the amount of money they receive from...

• Clinical trials: 10 easy steps to assess your risk

  Auditing and monitoring clinical trials is a must for any organization that performs clinical...

• Radiology: Aggressive mammography audits boost detection and cancer analysis

  Perform clinical audits of mammography services to make sure your organization is doing its best to...

Issue 7, July 1, 2003 - VIEW THE FULL ISSUE

• Medical necessity: Tips for auditing your facility's claims denials

  Claim denials for lack of medical necessity can significantly reduce an organization's bottom line...

• Strategies for examining diagnostic testing in the emergency room

  The quick and urgent pace of patient treatment in the emergency room (ER) opens it to myriad...

• Tips for interviewing and evaluating auditors

  Hire a new auditor with the same approach you use to audit. By organizing your search, you will...

Issue 6, June 1, 2003 - VIEW THE FULL ISSUE

• Copayments: Strategies for auditing your organization's collection efforts

  Consistently waiving copayments may be a recipe for disaster. Not only do you miss out on...

• Watch for employee conflicts of interest in vendor gratuities

  When the Office of Inspector General (OIG) released its final compliance program guidance for...

• Tips for preparing your sample selection

  The sample selection process is one of the most significant audit pieces. It shapes the entire...

• Rehab: Now is a good time to start auditing your claims

  Now that the prospective payment system (PPS) is no longer brand-spanking-new to inpatient...

• HIPAA: How to test information security

  The security portion of the Health Insurance Portability and Accountability Act of 1996 requires...

Issue 5, May 1, 2003 - VIEW THE FULL ISSUE

• Strategies for auditing and monitoring HIPAA compliance

  Now that your organization has implemented the Health Insurance Portability and Accountability Act...

• Beyond the basics: Auditing E/M coding and documentation

  you're looking for a big return from your audit resource investment, consider auditing physician...

• Payroll audits: Look for holes in your salary process

  Your facility doles out millions of dollars each year in employee salaries. To make sure your...

• Assess your organization's risks during construction

  Even if you don't know a philips head from a flat head screw driver, you can play an important role...

Issue 4, April 1, 2003 - VIEW THE FULL ISSUE

• The ABCs of auditing for inaccurate DRG assignments

  Diagnosis-related group (DRG) upcoding has been on the government's plate for the last eight...

• Your step-by-step guide to effective EMTALA compliance audits

  Does your organization include the Emergency Medical Treatment and Active Labor Act (EMTALA) among...

• SNFs: Self-audits can head off trouble

  Performing a self-audit on the Medicare billing of your skilled nursing facility (SNF) may seem...

Issue 3, March 1, 2003 - VIEW THE FULL ISSUE

• HIPAA countdown: Conduct privacy assessments to verify effectiveness

  Establishing good privacy policies, following comprehensive business policies, and deploying...

• Integrate OIG's assessment and analysis process with mock audits

  Many organizations live in fear that the government may uncover an unknown problem during an audit...

• Compliance and auditing: A match made in heaven

  Compliance audits, in their never-ending effort to reduce risk, legal and financial exposure, and...

• Are you a hospital-or a high-priced hotel?

  Your organization may pride itself on caring for patients efficiently. However, if it is so...

Issue 2, February 1, 2003 - VIEW THE FULL ISSUE

Issue 1, January 21, 2003 - VIEW THE FULL ISSUE

Issue 18, February 8, 2003

• Inpatient bad debt audits

  Inpatient bad debt audits

• HIPAA security auditing and monitoring

  HIPAA security auditing and monitoring

• Infection control risk assessment

  Infection control risk assessment

Issue 18, June 8, 2003

• Auditing same-day readmissions

  Auditing same-day readmissions

• Credentialing audit checklist

  Credentialing audit checklist

• Sample compliance program testing process

  Sample compliance program testing process

• Audit tool for coding

  Audit tool for coding

• EMTALA audits: Gather these documents

  EMTALA audits: Gather these documents

Issue 2, February 21, 2003

• Auditing for APCs: Is your facility billing and coding accurately?

  When much of your facility’s billing depends on accurate and timely use of thousands...

• Managed care: Determine whether you are complying with state prompt-pay regulat

  State regulators are closely monitoring whether payers are paying claims within required time...

• Tips for auditing inpatient bad debt

  Last year, the Office of Inspector General (OIG) released report after report on its audits of...

• Validate compliance program effectiveness through auditing

  Perhaps your organization has a great auditing and monitoring program, the right committees, a...

Issue 1, January 21, 2003

• Are your organization’s credentialing and privileging practices making th

  It’s more important than ever for hospitals to make sure that all medical staff members are...

• Find and monitor all conflicts of interest in your organization

  Last year, it was impossible to miss the endless barrage of news stories about executives...

• Get ahead of the curve

  How to adopt the Sarbanes-Oxley Act provisionsA new law could potentially change the way health...

• These auditors know best

  Plan this year’s audit program around your organization’s top risk areasAuditors will...

• Tips for auditing same-day readmissions

  Your hospital may try its best to treat and discharge patients efficiently. But if you routinely...