Practice Management Articles
Managed Care Audit Tips and Checklist
Casting fear into the bravest of managers…"AUDIT NOTICE"!. With proper preparation, any audit can be faced with confidence. The secret is knowing what the auditors will be looking for in the office and your charts. The managed care audit does not focus only on the chart audit; they look into all aspects of the office operation. The auditor will review the physician's updated medical licenses, DEA, DPS and Malpractice Insurance coverage. A site check will include the following areas:
Exam/Treatment Patient Care Areas
Appearance and Access
Safety and Emergency Protocols
Medical Record Keeping
Each managed care auditor will have specific forms to follow in these areas. The forms will vary from company to company, but will generally follow OSHA and CMS guidelines. These audits will also vary in specialty; i.e., what is required for an OB will be more detailed than what would be required of an Ophthalmology office. This can be the proverbial "tow birds with one stone". OSHA and CMS office compliance will also cover most managed care audit areas. While the penalties are not in the CMS or OSHA range a general overview and quarterly review should be in your office management protocols.