Compliance Audits

It involves evaluating past and present claims to ensure their alignment with both Local and National Coverage Determinations as well as payer-specific guidelines (LCD) to maintain compliance.

The complete compliance audit cycle comprises four primary phases: Preparation, Execution, Reporting, and Follow-up.

Email encryption safeguards both the email's content and any attachments from unauthorized access when they fall into unintended hands. In our organization, we enforce email encryption and the protection of passwords as part of our heightened security and compliance protocols.

It serves as a reliable audit trail, ensuring the implementation of appropriate follow-up actions and enabling the tracking and identification of potential billing and coding issues over time. Furthermore, this report can be a valuable tool for conducting thorough account analysis.

Consistent Education and Feedback: Demonstrating unwavering commitment, we prioritize continuous education and feedback. We conduct regular audits of physicians' medical records, using any inconsistencies as valuable opportunities for educating our medical professionals.

You can indeed take into account the ROS, past medical history, social history, and family history documented by ancillary staff, provided that the provider’s documentation confirms their review of these records. However, it is important to note that the history of the present illness must be conducted and documented by the physician.

Employees across diverse healthcare roles, such as coding and billing, are mandated to receive training in relevant areas like HIPAA, HITECH, etc., promptly upon joining the organization and subsequently on an annual basis. Additionally, training sessions are scheduled whenever there are updates to existing regulations or the introduction of new ones. Our seasoned training team diligently oversees compliance with these requirements for all our employees.

Included among the reference resources are OIG, the Centers for Medicare & Medicaid Services, the U.S. Department of Health & Human Services, and AAPC. These esteemed organizations offer a wealth of informational articles, auditing software, updates and alerts, compliance insights, and a wide range of valuable content.