Physician practices and all providers billing to any government-funded payers (eg, Medicaid, Tricare) are required to have a compliance plan per the Patient Protection and Affordable Care Act of 2010 (specific requirements for physician practices have not been designated at this time). The Office of Inspector General of the US Department of Health and Human Services and the Health Care Fraud Prevention and Enforcement Action Team (HEAT) have offered provider compliance training (https://oig.hhs.gov/newsroom/video/2011/heat_modules.asp), which advises to proactively audit coding, contracts, and care (eg, meeting standards of a value-based payment program). This issue of AAP Pediatric Coding Newsletter™ will focus on how to plan for and conduct internal auditing of documentation and coding.
An internal audit process provides a measure of how well your practice is maintaining compliance, education, and, as needed, correction. In addition to federal and state mandates that require compliance programs, an intentional effort to...
