Compliance self audits should be conducted periodically, either internally or through an outside source. An external survey can be quite daunting, especially those that are by a surprise visitor like a payor source or regulator. Preparation is the key and mock audits are the easiest way to reduce stress and ensure survey readiness at all times.
Larger healthcare corporations typically dedicate an entire department focused on ethics, compliance, risk, and patient care and safety. Smaller companies may rely on their compliance officer or an outside vendor. Both models also need to have their senior management and providers on board in not only cooperating with the compliance mock self exercise, but willing to support in addressing any deficiencies revealed. During a mock compliance survey, risks may be identified, revisions to policies and procedures and staff education and training may be necessary, and other items recognized as areas for improvement.
Sample coding, billing and employee file assessments would want to be conducted as an overview of their condition as well. Is reimbursement up to par? Is the revenue cycle running like a clock or could the return on investment be more profitable? Upon conducting a mock survey and identifying processes for improvement, a provider just might find that tweaking the coding, billing and collections efforts have not only improved patient documentation, but overall outcomes as well. Remember the 60-day rule if overpayments are found and act accordingly to refund the payor source appropriately and timely. Some providers may even consider consulting their healthcare attorney if significant findings are revealed. Identification of patterns, trends and performance will be evident by using the data collected during this process. Create metrics, track improvement and be proud to present your audit results to the governing board; and most of all, to anyone else that might want to take a look at the business. Don’t be surprised by what an auditor might find, be aware of what is there. Don’t be a scared provider, be a prepared provider!