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Self Audit Process
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Overview

The Office of Inspector General’s Compliance Program Guidance states that health care providers should incorporate “the use of audits and/or other evaluation techniques to monitor compliance and assist in the reduction of identified problem areas” into their ongoing compliance efforts. CCI has developed a self-audit process that is intended to assist our clients in accomplishing this task on an ongoing diligent basis.

Our self-audit process is specifically intended to provide the tools necessary to perform periodic billing and coding reviews, and, in so doing, appropriately document the claims reviewed, the findings identified, and any necessary follow-up action. Review protocols have been developed for both the Billing and Registration activities, and the Medical Records function.

CCI has also developed specific review criteria for numerous patient care service areas including:

  • Inpatient Acute
  • SNF
  • Psych and Rehab
  • Various Outpatient Services
  • Home Health
  • Physician Services
  • Emergency Transports

CCI has also designed separate review forms on which to document each and every patient encounter to be audited. By incorporating a series of “yes/no” questions within these forms, the specific answers to the various review criteria will serve to facilitate the immediate identification of potential issues or problem areas and their documented resolution.

This self-audit process was developed in response to concerns expressed by our clients relative to the ongoing auditing and monitoring aspects of their respective compliance programs. Because of the significance placed on recurring claims reviews by the government, and in light of the obvious need to document any and all such review activities, our standard process, along with the utilization of standard forms, is an effective and economical means by which to fulfill your unique auditing and monitoring requirements.

Other than identifying the specific patient care service areas to be encompassed by the reviews, clients need only identify the appropriate sample sizes and review frequency. The forms reflect all of the necessary review criteria, although any provider-specific problem areas and/or new initiatives identified by the government can readily be incorporated into the forms and the review process.
 

 

 

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