In today's risk-based world, healthcare organizations have to comply with a complex set of healthcare laws that govern their business practices. The government requires each healthcare organization to implement a compliance program that is effective in detecting and preventing future risks in order to address new challenges and meet legal standards.
The Office of the Inspector General has articulated seven components that make up the basic framework of a successful program, and one of the most important is compliance auditing and monitoring. It is also one of the most complex. To have a successful compliance program, you must show that your plan is actually improving compliance. Auditing ensures that you have a working program that serves as a "preventive medicine" for the "business of medicine." An effective compliance auditing and monitoring program may allow an organization to detect non-compliance prior to significant risk impacting the organization. Compliance auditing measures the organization's current level of compliance. As the compliance program matures, it detects higher level of compliance.
Auditing and monitoring together basically make up an assessment of a healthcare organization's operations and controls. Analysis of monitoring activities may indicate areas that require auditing, and vice versa. The results of your audit will reveal key areas that should undergo routine monitoring
At ProMed Services, we have more than 30 years of experience in the healthcare industry. Our certified auditors, coders, and compliance officers can assist your healthcare organization in implementing an auditing and monitoring program or work with the existing program.
ProMed Services also offers updates on specialty specific coding rules and regulations, compliance auditing of documentation for both ICD-9 and ICD-10, ICD-10 documentation review and training as necessary, and evaluation and management documentation training.
Compliance and HIPAA training is available for staff, physicians, advanced nurse practitioners, physical therapists, chiropractitioners, podiatrists, and more.
The team at ProMed Services can also assist with record requests from government audit services, such as recovery audit contractors.
Note that compliance auditing is a process carried out by an outside group, such as ProMed Services, to assess whether and how well regulations and standards are being followed at a practice.
Compliance monitoring is an ongoing process to be carried out by a practice's specific compliance program's managers. An audit can reveal what needs to be done to maintain compliance, after which the ProMed team can help establish a monitoring program to give any practice a framework for ongoing and constantly improving compliance efforts.
The two components—compliance auditing and monitoring—go hand in hand. The idea is that a successful monitoring program in place will result in fewer problems turned up by a future audit.
Learn more about the compliance auditing services offered by New Jersey's Professional Medical Management Services, including medical auditing by a medical coding auditor. Call (856) 840-5570 or contact us online.
A thriving healthcare organization must successfully navigate the complexities of modern business and healthcare compliance requirements. Professional Medical Management Services specializes in consulting with practices to provide help with the physical office and staff, coding and billing training, software selection and setup, policy and procedure implementation, HIPAA and ICD-10 training, and more.