Medicaid Audits verifies: Medicaid reimbursable services were rendered for the dates billed Appropriate rate or procedure codes were billed for services rendered Patient related records contained the documentation required by the regulations Claims for payment were submitted according to the Department of Health regulations and the appropriate provider manuals
Compliance Process For Corrective Action: Define the problem Define the root cause Define the actions necessary to correct or prevent the problem Define the actions to prevent recurrence of the problem or a similar problem Develop an implementation plan Educate the staff Audit the process again to ensure improved compliance and successful implementation.
Self-Audit is defined as the audit, examination or review performed within a physician’s office or health care organization. It focuses on assessing, correcting, and maintaining controls to promote compliance with applicable laws, rules and regulations. It has the following benefits: Reduces fraud and improper payments Improves patient care Lowers the chance of an external audit
-> Continue reading Compliance Reminder: Self-Audit
Integrate Compliance and Quality Keep it simple Document everything Assign accountability Check for understanding Define Key Performance Indicators Measure results Evaluate periodically
Effective problem-solving is key. Conducting an inventory process and identifying gaps and conflicts is important.
Treat Compliance as an ongoing, dynamic effort. It is not just steps towards periodic guidelines, but a mindset of continually improving ways on how we do business.
Plan for continuous improvement Plan Do Check Act
The three C’s of Compliance Communication Confirmation Correction
The US health care system is moving from a fee-for-service model to a valued based model. Instead of rewarding volume, it values cost, quality and outcome measures. OMIG cautions to comply with mandatory compliance program requirements. Providers need to identify where they can update risk-assessment activities and go beyond billing and coding. They need to
-> Continue reading Compliance Reminder: U.S. Healthcare System Moves to Value Based Model
Web address for Compliance department is compliance@acppps.org