Developing Coding Audit Plan and Monitoring Fraud

Compliance and Leadership
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Compliance and Leadership
Introduction
Adherence to regulatory mandates and reimbursement protocols is crucial in the intricate healthcare environment. Healthcare organizations must regularly assess their practices as part of Domain IV of Revenue Cycle Management to guarantee compliance with rules and reimbursement criteria. The creation of a coding audit plan using the Office of Inspector General (OIG) work plan, policies and procedures for keeping an eye out for fraudulent activity or abuse, and the interactions between payers and providers in the context of audits and fraud monitoring throughout the healthcare delivery system will all be covered in this paper.
Developing a Coding Audit Plan
To find and fix any problems with coding accuracy and compliance, an organization must develop a coding audit plan. It is advisable to methodically establish the frequency and percentage of charts that need to be audited. The following elements must be taken into account:
Frequency of Audits: Healthcare companies must decide how frequently audits will be carried out to have a coding audit plan that works. The frequency ought to be customized according to the size, resources, and risk considerations of the firm. Larger organizations are often advised to perform quarterly audits; smaller ones may perform audits every other year or semi-annually. On the other hand, when there are significant coding changes