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Health Care Auditing Strategies

Issue 12, December 1, 2004 - VIEW THE FULL ISSUE

• Not getting right reimbursements?

  Congress. The OIG. Fiscal intermediaries. CMS. They all have some say in how reimbursement flows...

• Risk assessment: Use questionnaires to identify management's top issues

  One of the best ways to obtain information about the risk exposures facing your organization is to...

• Physician practice: Audit to verify compliance, efficiency

  Audits are essential to determine whether you are achieving your physician clinic's goals and...

• Coding audits: Review priorities, validate findings

  The government wants you to do more than go through the motions of a compliance program. Your goal...

• Batten down the hatches against false claims suits

  More than 75% of successful whistleblower actions in 2003 came from healthcare. Use these human...

• Sample organizational risk questionnaire

  Sample organizational risk questionnaire

Issue 11, November 1, 2004 - VIEW THE FULL ISSUE

• Use risk-based auditing to maximize time and resources

  Get more out of your audits by using a risk-based approach instead of traditional audit...

• Review contracts to ensure prompt and accurate reimbursement

  Ensure that your organization is auditing its managed care contracts in order to maximize...

• OIG 2005 Work Plan: What you need to know

  Last month the Office of Inspector General (OIG) released its 2005 Work Plan, a list of projects it...

• Fee matrix ensures accurate third-party reimbursement

  Think your coding is meticulous? Barbara Watson, a consultant and administrator at Lexington...

• Incorporate SOX into internal investigations

  Several key government laws and guidelines have increased the emphasis on internal investigations...

• Reimbursement spreadsheet

  Reimbursement spreadsheet

Issue 10, October 1, 2004 - VIEW THE FULL ISSUE

• Streamline claims audits

  Hospitals lose an average of $1,000 a day due to denied claims. Outpatient sites lose $1,200 a day...

• Reconcile employee health benefits and insurance premiums

  Employee health benefits administration is a good candidate for a value-added internal audit. An...

• Clinical research: Review human subject protections

  Organizations that conduct research on human subjects must meet myriad regulations for protecting...

• Audit home health agency efficiency, compliance

  If your hospital or health system owns a home health agency (HHA), review it as part of your audit...

• Efficient benefits process

  Efficient benefits process

Issue 9, September 1, 2004 - VIEW THE FULL ISSUE

• Consultations: Help your practice meet Medicare's billing criteria

  Your physician practice may be losing significant revenue if it is not billing appropriately for...

• Review procedure coding for correct reimbursement and compliance

  Ensure that your practice properly bills for in-office procedures in order to receive accurate...

• Audit medical necessity to increase reimbursement

  Each year, healthcare facilities face increasing pressure to remain financially viable as the cost...

• HIPAA: Verify employees' privacy compliance

  Audit your facility's compliance with the HIPAA privacy rule to verify that employees are following...

• Checklist for employee privacy compliance

  Checklist for employee privacy compliance

Issue 8, August 1, 2004 - VIEW THE FULL ISSUE

• Assess your audit program using new compliance guidelines

  Make sure your organization's compliance program is up to date as part of your ongoing assessment...

• Scrutinize credit balances to help ensure prompt Medicare repayments

  Your job of ensuring compliance doesn't end when the facility bills the patient or FI. You must...

• Improve the revenue cycle process-while increasing your facility's financial hea

  Despite their focus on healing, hospitals are businesses. Add value to your organization by helping...

• Test staff's ability to respond to and assess clinical alarms in your facility

  Does your staff know how to listen for, and respond to, all of the clinical alarm systems on your...

• Anti-kickback statute compliance

  Assess anti-kickback statute compliance

Issue 7, July 1, 2004 - VIEW THE FULL ISSUE

• Time is running out for hospitals to comply with Stark II Phase II

  Hospitals have precious little time to get their contracts with physicians in order before Stark II...

• Evaluating physician coding profiles

  To correct faulty processes and optimize your coding and billing practices, evaluate physician...

• New CMS guidelines clarify EMTALA compliance

  Hospitals now have more information concerning compliance with the Emergency Medical Treatment and...

• Attorneys answer your top coding audit questions

  Editor's note: The following is based on a session held during the Twelfth Annual Conference of the...

Issue 6, June 1, 2004 - VIEW THE FULL ISSUE

• Enforcement update: Target audits to the latest government initiatives

  You'll never have to worry about running out of issues to audit within your organization. The tough...

• Safeguarding your organization's goals

  Part I of II Identifying potential barriers to your organization's success should be your top...

• Evaluate preventive-visit and problem-visit documentation in six easy steps

  When it comes to reviewing levels of physician services, it is crucial to distinguish between...

• Assess patient safety to avoid fraud allegations

  Patient safety is at the top of the government's list for fraud enforcement, so make sure it is...

• Patient safety auditing-and-monitoring plan

  Patient safety auditing-and-monitoring plan

Issue 5, May 1, 2004 - VIEW THE FULL ISSUE

• Develop policies and procedures to guide the auditing process

  Your audits may not be as valuable and efficient as they could be if your organization doesn't have...

• How to audit modifier use

  If your facility is not monitoring how it uses modifiers, it is putting itself at risk for an OIG...

• Review your facility's contingency plan for protecting medical records

  It's not enough that healthcare organizations have to worry about the possibility of disasters...

• Policy: Monitoring and auditing process

  Policy: Monitoring and auditing process

• Inpatient bad debt audits-2

  Inpatient bad debt audits-2

Issue 4, April 1, 2004 - VIEW THE FULL ISSUE

• Review utilization program to test your organization's clinical controls

  If your audits only focus on business aspects of your organization, you could be ignoring important...

• Mitigate construction risks using 10 easy-to-follow guidelines

  Audit departments that regularly analyze contracts for payment issues aren't doing enough in...

• Ensure compliance with HIPAA's transactions standards

  HIPAA's transactions standards offer healthcare organizations significant benefits, including...

• How to create a successful monitoring program

  Auditing on its own is not enough to maintain an effective compliance program-organizations must...

Issue 3, March 10, 2004 - VIEW THE FULL ISSUE

• Use these four easy steps for physician documentation

  Although you can expect physicians to maintain complete medical record documentation, you must...

• Simple plan helps hospitals audit 3-day payment window compliance

  Your hospital might be missing out on reimbursement if it unnecessarily bundles services that occur...

• Four simple steps to audit cardiac-cath billing

  The financial stakes are high for billing and coding of cardiac catheterization (cath) services.

• Mental health: Audit therapy notes for accuracy

  Audit your organization's mental health documentation to verify that all services provided are...

• Pediatric record audit tool

  Pediatric record audit tool

• Three-day window audit worksheet

  Three-day window audit worksheet

Issue 2, February 1, 2004 - VIEW THE FULL ISSUE

• Increase cash flow by identifying and reducing claims denials

  Claims payments and denials are the "pass/fail grade of the revenue cycle," according to Jean...

• How to audit ABN use

  Protect your facility from fines and loss of revenue by auditing compliance with advance...

• Sanctions: Verify your organization's process for identifying excluded individua

  Under the Social Security Act, providersincluding hospitalsface up to $10,000 in civil monetary...

• Ensure compliance with Medicare secondary payer regs

  Ensure that your hospital is making a good-faith effort to identify Medicare patients who have...

• Test your coding audit skills with real-life scenarios

  Editor's note: HCAS and Lolita M. Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort...

• ABN audit steps

  Policy review. Hank Vanderbeek offers the following process.

Issue 1, January 13, 2004 - VIEW THE FULL ISSUE

• Ensure Stark, anti-kickback compliance for physician contracts

  The physician self-referral law (Stark) and the anti-kickback statute place strict regulations on...

• Cardiac rehab: Ensure compliance in top OIG focus area

  Make sure your hospital is complying with Medicare's requirements for outpatient cardiac...

• Eleven steps for HIPAA audit planning

  You devote countless hours and resources to bringing your organization into compliance with the...

• Quality of care

  Quality of patient care has quickly become one of the government's top target areas. Today, quality...