External Audit Paper

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On the other hand, an external audit is controlled by outside agency, such as the Office of the Inspector General. Healthcare organizations should respond to external investigators’ request punctually. Organizations need to develop and follow the policies and procedures for response to external audits in order to protect the patients’ right of confidentiality. The very first step that organizations must practice is identifying the origins and authorities of the individual and organization that issue the request. They can verify the identities by various methods, such as: checking information on the states’ website and calling states’ offices for Medicare and insurances companies. Once identities are confirmed, organizations can proceed to the …show more content…

Keeping tracking records of the responses is the next step that organizations must implement. The records should include the name of carrier service and the person accepting the packages, and the date and time when they were sent. (Safian, 2009, pp. 189-190). The main purpose of external audits is to retrieve the overpayment. When healthcare organizations receive the audit results showing that they have been accepting extra amount of reimbursements for the services that they provided, the auditors require the organization to repay the funds and fines associated with the misconducts. However, the organizations have the right to appeal the results if they believe that the decisions are inaccurate. First, the organization should develop appeal team, whose members should come from every department that involves in Medicare claims, such as HIM coding specialists, billing staffs, financial staffs, case managers, clinical professionals, and one of the organization leaders. The team should estimate the audit results to determine if the overpayment is appropriate or not. If it is, then the organization should modify the compliance policies and procedures to avoid the same mistake in the future. If it is not, the team should discuss to see whether it is worth

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