Audits: Get your strategy
A. From the moment an audit letter lands in your mailbox, to the day the files are organized and ready to go out the door, it is important to have an audit response strategy. Establishing a step-by-step process will ensure timelines are met and all the necessary documentation is included in your response. It may also be beneficial to designate an individual to be responsible for the audit responses. The steps below are a good framework to get started.
• Read the request carefully and identify the auditor and the due date. Response times will vary based on the auditor and audit type. Be sure that you are tracking both the date of the request and the due date.
• Determine what type of documentation is being requested. Again, audits vary not only by contractor but by type. DME MACs conduct supplier documentation audits that only require one or two documents in the response. ZPICs may require an entire patient file without referencing specific dates or equipment. It is important to read carefully and respond with what was requested.
• Review your documentation. Pay attention to physician signatures, both for legibility and also on medical records. Review policy guidelines to ensure requirements are met. When necessary, obtain signature logs, properly documented amendments, and attestations.
• Neatly compile your response and save a copy for your records. Submit to the designated address/contractor and track the receipt.
• Lastly, calculate the expected date for an audit response and follow up with the contractor, when possible, if that deadline is exceeded.
Remember that a timely response is just as important as the documentation contained in the response. Also, an organized and complete response will be easier to review and could lead to more favorable outcomes to include lesser audits in the future.
Kelly Grahovac is senior consultant at The van Halem Group. Reach her at email@example.com.