Is Your Practice Ready for an Audit?

Now that audits are resuming in full force, it is essential that your practice is ready. Failure to prepare could result in large fines and loss of patient trust.

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Failure to plan and prepare for an audit can lead to disastrous results. If you fail to catch mistakes in your billing, you may face hefty fines from the United States Department of Health and Human Services (HHS).

A recent settlement was reached by HHS and Great Lakes Medical Laboratory, Inc. for allegations of a fraudulent billing scheme. Great Lakes will pay over $1,200,000 and enter into a three-year Integrity Agreement that requires Great Lakes to hire an Independent Review Organization to review certain claims, among other requirements.

It is essential to prepare your practice for an audit now.

How do you prepare your practice for a potential government audit?

First, start by looking at your last audit results. Did you perform an internal or external audit most recently? Did you correct any areas of concern? If you performed an internal audit or if it’s been awhile, it might be time to hire a healthcare attorney to help with an external, but attorney-client privilege protected audit.

Was your last audit sufficient? Were each of your providers charts audited? When you review your audit, make sure that:

  • There is a sufficient sampling of each practice location (office, clinic, hospital, etc.),
  • Each provider has a sufficient sampling,
  • There is a variety of payors in the sampling, and
  • Any issues were identified, trained on, and fixed.

Also make sure to evaluate your compliance plan. Your compliance plan needs to be more than a binder on a shelf – it should be a comprehensive plan. Your staff need to be aware of the procedures and updates.

If you need help with performing your audit or updating your compliance plan, contact Rickard & Associates today.

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, click here to Subscribe.

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