Healthcare Compliance Audit

Healthcare Compliance Audit

Annual compliance audits and consistent monitoring are part of an effective compliance program. If your healthcare organization is looking for ways to improve its compliance program, DoctorsManagement, LLC can help. Our compliance auditing services offer the comprehensive solutions you need to ensure compliance, reduce the risk of payor repayment audit, improve patient and physician satisfaction and boost efficiency.

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What Is a Healthcare Compliance Audit?

A healthcare compliance audit is a systematic review that ensures adherence to federal laws and internal policies. It identifies discrepancies in patient care processes, enhances operational efficiency, and ensures compliance with regulations like HIPAA. Compliance audits allow organizations to mitigate risks and improve overall patient safety.

Compliance auditing and monitoring are essential within the healthcare industry. Organizations must comply with federal and state regulations and internal policies to ensure patient safety and practice success. Incorporating compliance auditing into your compliance program helps keep your program effective.

Our Healthcare Compliance Services

DoctorsManagement can provide the healthcare compliance auditing and monitoring tools, resources and support you need to create a comprehensive and effective compliance program. We customize our compliance services to meet your unique needs, so you can trust that we’ll provide the best solutions for your organization. Three of our most prominent compliance offerings include:

  • Compliance program audits
  • Medical encounter documentation review and payor repayment consulting
  • Litigation expert testimony
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Healthcare Compliance Auditing

DoctorsManagement is here to support your organization with every healthcare compliance auditing need, enabling you to make your audit and review process successful. We can perform our compliance audits remotely or on-site, and we can provide real-time analytics to help you make adjustments quickly and efficiently.

Our internal audit follows this basic process:

  1. Our team will request your compliance plan and policies
  2. We review and analyze your audit and compliance program to identify gaps
  3. Our auditors present a concise report and discuss significant audit findings
  4. We offer consulting and educational sessions with hands-on training and feedback to help implement these recommendations

Medical Encounter Documentation Review and Payor Repayment Consulting

Our consultation experts can assist with medical encounter documentation reviews to help you ensure accuracy and thoroughness for optimal patient care and risk management. Our consultation services can also enable you to quickly understand payor repayment opportunities.

Litigation Expert Testimony

DoctorsManagement has an Advanced Healthcare Analytics division that specializes in litigation support. We work with healthcare organizations, private legal firms and state’s attorneys general to defend physician’s rights against regulating agencies and payors.

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The Importance of Auditing Corporate Compliance in Healthcare

Regular internal audits for compliance enable you to create comprehensive compliance programs that reduce your risk and improve operational efficiency. DoctorsManagement can simulate actual carrier audits to help you correct deficiencies and keep your organization on track toward total compliance. Our expert auditors can support and guide you to compliance solutions that work best for your practice.

As you conduct your medical practice in compliance with laws, regulations and internal policies, you can experience benefits like:

  • Improved performance
  • Enhanced patient satisfaction
  • Increased income
  • Reduced physician and staff stress

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Why Choose Our Team for Healthcare Compliance Auditing?

DoctorsManagement can perform healthcare compliance audits and audit training for any size organization, from solo practices to hospitals. Our audit team can also work with any specialty to provide the level of compliance your practice requires.

Experienced Auditors

Our expert auditors have years of experience in healthcare compliance. Every healthcare compliance auditor is dually credentialed as Certified Professional Medical Auditors (CPMA®) and Certified Professional Coders (CPC®), so you can trust us to offer full support and guidance throughout the audit process.

Comprehensive Solutions

As a full-service healthcare consultancy firm, we enable you to create comprehensive, effective and sustainable compliance systems that can keep your practice compliant for years. We can help with various operations, including coding, billing documentation, staff and provider training and a variety of audit types.

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Frequently Asked Questions

What is the purpose of a healthcare compliance audit?

A healthcare compliance audit ensures that a healthcare organization adheres to federal and state regulations, and follows internal policies such as patient care reimbursement. It identifies discrepancies in compliance efforts and recommends changes to improve compliance, operational efficiency, and overall practice success.

How often should healthcare compliance audits be conducted?

Healthcare compliance audits should be conducted annually as part of an effective compliance program. Regular audits ensure that organizations’ provders and or coders consistently adhere to regulations, identify potential issues early, and maintain a high standard of documentation in patient care and operational efficiency.

Which types of medical practices benefit from our services?

DoctorsManagement’s services benefit all types of medical practices, from long-standing clinics to brand-new startups. Our expertise extends across various specialties, making our consulting services valuable to any healthcare organization looking to enhance its compliance program.

What are the key components of a healthcare compliance audit?

The key components of a healthcare compliance audit include:

  • Reviewing and analyzing the existing compliance plan and policies
  • Identifying gaps in the current compliance program
  • Presenting a concise report of significant audit findings
  • Providing consulting and training to help implement recommended changes

How can organizations prepare for a healthcare payor compliance audit?

Organizations can prepare for a healthcare compliance audit by:

  • Ensuring their compliance plan and policies are up-to-date and well-documented
  • Conducting internal reviews to identify and address potential gaps
  • Training staff on compliance requirements and best practices
  • Engaging with experienced compliance consultants like DoctorsManagement for pre-audit consulting and support

What are the consequences of failing a healthcare compliance audit?

Failing a healthcare compliance audit can result in significant consequences, including:

  • A Payor repayment demand in the form of Financial penalties and fines
  • Damage to the organization’s reputation
  • Potential removal from a payor network
  • Potential revocation of a state medical license

How do healthcare compliance audits improve patient care?

Healthcare compliance audits improve patient care by ensuring that healthcare organizations adhere to regulations and best practices, which enhances the quality and safety of patient care.

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Contact Us for Medical Audit and Review Solutions

DoctorsManagement has the comprehensive and expert auditing services you need to ensure your organization is compliant. Contact us today to learn how our compliance auditing services can satisfy your unique compliance demands.

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DoctorsManagement does not work with patients. We offer support to medical practices.
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