Compliance Audits

Effective compliance programs demand an initial compliance audit, as well as ongoing monitoring of operations and compliance activities. Since 1997, when the OIG first published compliance guidance for laboratories, our analysts have performed initial compliance audits for laboratories and radiology practices of all sizes and across the country. Many of our clients also choose CodeMap® to perform annual audits, as required by OIG guidance.

We understand not only how the rules and regulations apply to providers, but also how laboratories and radiology practices operate. This combination of expertise allows CodeMap® to perform effective and useful compliance audits.

Our comprehensive compliance audits will assess your organization's compliance with the following: 

• Anti-kickback provisions;
• Stark II self-referral prohibitions;
• CPT^®/HCPCS coding rules and policies;
• Medicare billing rules and policies;
• ICD-9 coding rules and policies;
• Claims development and submission rules and policies;
• Medicare and Medicaid reimbursement rules and policies;
• Privacy Regulations of HIPAA;
• Reporting and record keeping rules and policies; and
• Any other rules and regulations governing participation in the Medicare and/or Medicaid programs.

Our compliance audits typically include: 

• Interviews with personnel involved in management, operations, billing, compliance, sales, and marketing;
• An analysis of all operations that affect how tests are ordered, performed, coded, and billed.
• An examination of all business relationships and alliances with other providers and suppliers;
• A review of all coding and pricing; and
• A written report describing all findings and recommended changes.     

Call Gregory Root, Esq. at 847-381-5465 for more information.