Question

Question:

There are two items to cover. First, define the term internal audit. In many cases the physician states they did not commit fraud, rather it was their staff that coded and billed inappropriately. For the second part of the discussion, discuss how an internal audit would help the practice avoid prosecution.

Note: Minimum word count for parts I and II is 150 words each. And a reference as well.

Answer 1

1. Internal audit is a process of assessing and evaluating an organization's workings- its operations, policies that govern those operations, quality processes and risk management.
2. An internal audit leads to identification of breaks in the system where healthcare is provided as well as detecting risks that hinder the organization in achieving its goals.
3. The best way to minimize errors relating to coding, billing and ultimately being prosecuted for billing fraud is to conduct regular coding audits and, if needed, billing audits which are a more elaborate dissection than coding audits.
4. Since coding is essential in order for the healthcare workers to be justifiably paid for the healthcare services they offer, the best way to start off would be to conduct a coding audit.
5. Sample patient charts of each physician could be studied and analyzed which would give a fair idea of breaks in the process of coding to which solutions may thus be suggested.
6. Alternatively, billing audits may be conducted which require use of many data sources and a comprehensive survey of medical and financial records.
7. Auditors can also identify staff education and training needs wherein the staff can be trained in correct coding protocols thus saving the practice a trip to the courts.