decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Model Compliance Plan / Step 1 - Audit and Monitor
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Article Overview
This article covers the first step in an OIG model compliance plan: audit and monitor. It outlines the purpose of ongoing evaluation, how organizations can review standards, claims, and documentation, and how baseline and periodic audits support compliance monitoring. The discussion is aimed at healthcare organizations, billing teams, coders, and compliance staff who need to understand general audit and monitoring expectations.
Why This Topic Matters
Audit and monitoring are core parts of a compliance program and help organizations identify risk areas, track performance, and respond to issues before they grow larger. This topic matters to providers and billing entities that want to maintain compliant claim submission and documentation processes.
What You Will Learn
- Why ongoing evaluation is part of an effective compliance program
- How audits and monitoring support review of standards, claims, and documentation
- The role of baseline and periodic audits in tracking compliance efforts
- General approaches to selecting records or claims for review
- How organizations may respond when audit findings identify a problem
Who Should Read This
- Healthcare providers
- Medical billing staff
- Coders
- Compliance officers
- Practice managers
- Revenue cycle teams
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