If you’re preparing to launch an audit within your healthcare organization, pause for a moment and consider this: how well you plan before the audit begins can significantly affect the outcome—and your risk exposure. This week on the podcast, we discuss the importance of pre-audit planning.
Audits can be proactive, part of a compliance work plan, or reactive, triggered by concerns raised internally or externally—such as a payer warning letter. Regardless of type, the planning steps are largely the same: identify who will conduct the audit, decide if the audit should be privileged, clarify what’s being audited, and determine your sampling strategy.
Choosing the right auditor is critical. Internal auditors must be objective and removed from the process being evaluated. If no qualified internal team exists, bringing in an external audit firm may be necessary. Cost, complexity, and confidence in internal compliance all play into that decision.
Equally important is deciding if the audit should be conducted under attorney-client privilege. This is especially relevant for reactive audits tied to legal risks or overpayments. To preserve privilege, it’s crucial that legal counsel be involved before audit work begins.
Clearly outlining the regulatory requirements tied to the audit issue is another must-do. Whether you’re reviewing claims for a missing modifier or validating physician certifications for Medicare, a well-defined scope helps ensure the audit findings are useful to the underlying goal.
Finally, consider what and how much to audit. A solid sample should be large enough to spot trends without overwhelming resources. And if an issue is uncovered—particularly if overpayments are identified—there’s a legal obligation to investigate further.
The bottom line: thoughtful pre-audit planning can help you avoid bigger compliance problems down the road.
(Ep. 68 is a replay of Ep. 13)
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