Clinical Scorecard: Compliance: Make Time for Internal Auditing
At a Glance
| Category | Detail |
|---|---|
| Condition | Healthcare Compliance |
| Key Mechanisms | Internal medical record audits, risk assessment, and monitoring |
| Target Population | Healthcare providers and practices |
| Care Setting | Clinical practices |
Key Highlights
- Regular internal audits are essential for compliance with billing and coding standards.
- The OIG's 2023 guidelines emphasize proactive compliance measures.
- High-priority audit areas include high-dollar procedures and diagnostic testing.
- Follow-up audits are critical to verify the effectiveness of corrective actions.
- Training should be tailored based on audit results and compliance risks.
Guideline-Based Recommendations
Diagnosis
- Conduct regular internal audits to assess compliance with billing and coding.
Management
- Implement corrective actions based on audit findings and prioritize issues.
Monitoring & Follow-up
- Perform periodic re-audits to ensure compliance measures are effective.
Risks
- Identify and address recurring compliance issues specific to services or providers.
Patient & Prescribing Data
Not specified; applicable to all healthcare practices.
Ensure claims documentation supports billed services with necessary consents.
Clinical Best Practices
- Utilize external audits every 1-2 years for an objective compliance review.
- Base training on internal audit results related to billing, coding, and documentation.
- Regularly review Local Coverage Determinations for compliance guidance.
References
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