Compliance Program Audit
The Compliance Program Audit is a two-part technical review of the
laboratory compliance activities. The Laboratory’s Compliance
Plan is validated to ensure that the written plan is current with
the Office of Inspector General (OIG) Hospital Compliance Guidance
and the Laboratory Compliance Guidance. In addition, the elements
of the plan are evaluated in terms of the active adherence to the
plan on a day-to-day basis. The second part of the review is a limited
audit of claims to identify claims processing errors.
Laboratory Coding Compliance
HSC validates the laboratory charge file CPT/HCPCS codes to ensure
appropriate revenue and to reduce the possibility of claims liability
due to incorrect coding.
Management Billing Analyst (Mba) Audit
Software
The MBA software application provides a statically valid audit and
is a cost-effective solution to meeting the OIG recommendation for
ongoing monitoring of claims. MBA gives laboratory compliance and/or
hospital compliance the ability to monitor laboratory billing and
payment procedures to identify weaknesses in internal systems, detect
errors, and monitor for systemic problems. The audit reports documentation
can be a mitigating factor in assessing culpability—potentially
resulting in reduced penalties and/or more favorable settlement
terms.
HSC Subscription Compliance Program
The Subscription Compliance Program provides a resource to the laboratory
compliance office for questions and concerns regarding laboratory
coding and billing. It is a simple, effective, cost-efficient solution
to the daily management of the complex issue of compliant coding
and billing of laboratory services.
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