Healthcare

Everything You Need To Know About Healthcare Compliance Audits

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Healthcare providers are increasingly becoming the target of regulatory agencies such as the Centers for Medicare and Medicaid Services (CMS). One way that these agencies enforce compliance with healthcare regulations is through. If you are a healthcare provider, it is important to know what these audits entail and how to prepare for them.

There are three main types of healthcare compliance audits: Medicare and Medicaid program audits, HIPAA privacy and security audits, and provider self-audits.

The CMS conducts Medicare and Medicaid program audits to ensure that healthcare providers are complying with Medicare and Medicaid regulations. These audits can be either desk reviews or on-site visits. Desk reviews are conducted through a review of provider documentation, while on-site visits involve interviews with staff members and observations of care being provided.

 

HIPAA privacy and security audits are conducted by the Office for Civil Rights (OCR) to ensure that healthcare providers are complying with HIPAA Privacy and Security Rule requirements. These audits can be either desk reviews or on-site visits. Desk reviews are conducted through a review of provider documentation, while on-site visits involve interviews with staff members and observations of care being provided.

Contractors conduct CMS quality audits on behalf of CMS to assess whether healthcare providers are meeting Medicare program requirements. These audits focus on specific areas of provider performance, such as patient safety, infection control, and medical records documentation.

Healthcare compliance audits are important tools for ensuring that healthcare providers are meeting both CMS requirements and HIPAA Privacy and Security Rule standards.