Compliance Corner

How often should a laboratory conduct compliance audits of its billing and coding?

The answer depends on many factors and will vary from provider to provider. The frequency of audits and reviews of billing and coding is a function of risk, size of the laboratory and complexity of its service offering, complexity of its client portfolio, how often critical changes occur in the laboratory’s billing and coding procedures, and the resources available to the compliance officer to conduct the audits and analyze the data. Audits of all facets of a laboratory claim submittal and the associated policies and procedures should be done at least annually. If the laboratory is very large, the audits may have to be split up and performed piecemeal over the course of a year in order to make sure every area is audited at least annually. High-risk or problematic areas may need more frequent audits to ensure accurate claims submittals are occurring.

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