Corporate Compliance

To err on a claim is human, to rebill improperly is no excuse

Healthcare Auditing Weekly, September 16, 2003

Every audit is a continuous process. And it is the follow-up portion of the audit that allows the process to come full circle. This is also the time to begin planning for your next audit.

The audit team is responsible for reviewing the accuracy of coded data, as well as the content of the actual claim that was generated for the coded data. Here are three steps the audit team should take today to improve this process:

1. Review whether the organization bills exactly what it codes. If there are differences between the coded items and the final bills, note this in the report as a deficiency.

2. Work with the business office to rebill the claim correctly and to determine the cause of the error.

3. Provide in the report to the business office a listing of all cases to be rebilled.

As part of the follow-up process, the audit team should require some proof of rebilling. One option is to ask the business office to submit proof to the audit team within five business days of the report. This documentation may be sent in electronic or hard-copy format.

The audit team must keep it as part of the trail showing that the rebilling/repayment process occurred in a manner consistent with the audit findings.

For more information on audit follow-up and how to address significant coding, physician documentation, and information systems concerns, order the book "Coding Compliance: A Practical Guide to the Audit Process." This book provides step-by-step guidance on how to conduct an audit--from educating the hospital about the need for them and then carrying them out--to follow-up activities and attorney-client privilege, like how to obtain it and when it's appropriate to seek it. Click here for more information or to order.

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