The Types of Healthcare Compliance Audits

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By Carol Miller RN MBACarol S. Miller

There are several types of audits that a healthcare organization might need to perform.

The starting point is to obtain a baseline audit.  Next steps include periodic audits or reviews that are performed after all the information is obtained from the baseline audit; periodically. Finally, there are new employee audits.

Additional audits can be performed whenever new employees are added or if there are complaints or issues that arise in the course of business.

The Types:

  • Self Audit. Routine self-assessments demonstrate proactive measures established to ensure compliance and thus reduce the likelihood of a failed audit
  • Baseline Audit. Baseline audits are preliminary assessments to develop a reference point. This preliminary audit can help an organization understand where the program is and establish a base to gauge or compare future activities. Without this initial assessment, it is difficult for anyone within the practice or even an external consultant to determine if there are any performance issues.
  • Periodic Audits. Periodic audits are performed on an on-going basis, based on the decision of the practice. They may occur at random or at a scheduled time, monthly or quarterly.
  • New Employee Audits. New employees require regular training and reviews until there is confidence in their capabilities. Background checks are helpful to find out whether there are any potential conflicts; however, many independent medical practices do not have access to this type of information and may have to rely on other organizations to obtain the information. The OIG and General Services Administration maintain a database of excluded persons and entities that can be accessed through the internet. As part of the organization’s initial and periodic audits, queries of these two databases should be performed for all employees and any independent contractors.



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One Response

  1. MD’s Victory in MU Appeal May Be Good Sign in World of Punishing Audits

    Wyoming surgeon Razi Saydjari passed his meaningful-use audit with flying colors except when it came to the security risk assessment. He flunked that, according to the auditors hired by CMS to audit physicians and hospitals that had accepted payments to adopt certified electronic health records (EHRs). If they are out of compliance with any of the dozen or so core measures, CMS takes back the entire EHR incentive payment for the audit period. That could have happened to Saydjari, but he won his appeal of the audit, against all odds, according to his attorney, which means the surgeon will keep his $18,000 EHR incentive payment for 2012.

    Saydjari’s experience captures many of the aspirations and shortcomings of the EHR incentive-payment program. They include the dismay of healthcare organizations hit by the all-or-nothing nature of meaningful-use audits, the surprising room to maneuver with auditors, the possibility of prevailing during the unconventional CMS appeals process, and the persistent gaps in security risk assessments.

    Source: Nina Youngstrom, Health Business Daily [4/27/16] via Report of Medicare Compliance


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