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Offensive and Defensive Strategies for Using Automation to Enhance the Compliance Process

defensive-strategies1Every day, practices put themselves at risk being audited, or even fined, because they aren’t in compliance. Thankfully, technology can help by enabling practices to better detect, monitor and prevent potential compliance issues. When utilized as part of a comprehensive compliance plan, practices can both avoid self-inflicted costly audits and ensure the collection of accurate payment.

If you’re ready to step up your compliance game, here are a few offensive and defensive strategies to keep in mind:

1. Offense: Review your query process. Make sure your process effectively bridges the gap between the clinical language used by providers and the selected medical codes. Queries can be applied concurrently, pre-bill or post-bill, and can help ensure your clinical documentation supports your coding.
2. Defense: Implement a compliance plan. A documented compliance plan may make the difference between determinations of fraud and abuse. Keep a record of the ways you implement your compliance plan, including who was trained and when along with any efforts you made to address potential compliance issues.
3. Offense: Use electronic coding and coding advice tools. Automation can help practices manage changing regulations and submit more accurate claims. Electronically searching for the correct ICD-9/ICD-10 codes, HCPCS and modifier is much more efficient and effective than relying on cumbersome code books.
4. Defense: Establish a process for tracking audit requests and outcomes. If you do receive a Recovery Audit Contractor (RAC) or other audit request, have the response procedures defined and in place along with the resources to manage the entire process.

For more tips on streamlining and improving the compliance process, register for the 2014 MGMA Compliance Virtual Academy on April 24. We hope to see you there!