Corporate Compliance

Top 10 tips for laboratory audits

Healthcare Auditing Weekly, November 11, 2003

The government and third party payers are aggressively auditing physicians and their practices, according to Rick Oliver, JD, CHCO, CPC, MT (ASCP), director of compliance at AmeriPath, a national diagnostic testing provider. Use these strategies in your laboratory audits:

1. Make sure your audit team has expertise in the following areas:

·  Payment mechanisms

·  Coding rules

·  Medicare guidance/regulations

·  Other payer requirements

·  Ability to identify best practices

2. Identify which patient cases to audit and select the appropriate audit sample. For example, pull 10 random charts covering all carriers, Medicare, Medicaid, third party private payers, and others. Focus on the last six to 12 months, if possible.

3. Gather the appropriate reference materials, such as codebooks, official manuals and bulletins, newsletters, staff notes, etc.

4. Gather the appropriate patient-specific information. Collect medical record documentation, correspondence, lab requisition sheets, and HCFA 1500 forms.

For more information on laboratory audits and a sample audit plan, order the pay-per-view article "Laboratory audits: How to test for common billing and coding errors." The article costs $10. Subscribers to the online version of Health Care Auditing Strategies have free access to it. Subscribers to the print edition can find it in their September issues.

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