When possible, the Division of Program Integrity works with the provider to minimize inconvenience and disruption of health care delivery during the audit. Providers can prepare by doing the following: 

 

Provide a temporary work space for the auditor(s) within reasonable proximity to the office staff and records. Since many of the original documents and records we will need to examine are located at the local department level, the auditor(s) will need a temporary work area with adequate space and lighting. The amount of time needed for the auditors to be physically present at your location will vary from audit to audit. We will attempt to perform as much of the audit as possible from our office so as to minimize any disruption of your operations.

 

Provide a current organization chart of your area of responsibility. This and other information will assist the auditor in gaining an understanding of your administrative structure, nature of your operations and familiarity with your employees.

 

Have a designated individual (Clinical Manager, Clinical Administrator, or Administrative Staff Person) available to assist the auditor. 

 

The auditor's analysis of your operation may require that several of your employees at various levels be asked to explain organization process.  In addition to examining hard copy records, it may be necessary for the auditor to make photocopies, and/or obtain samples, of key documents for our files. The confidentiality of records reviewed during the course of the audit (i.e.: payroll data, personnel record details and contractor agreement details, etc.) will be maintained by the auditor(s).

 

Have all documentation to support billing and reimbursement readily available for the reviewer. 

 

Have copies of current business license(s) and professional healthcare licenses of all pertinent staff available for the auditors. 

 

What happens during an onsite audit? 

 

Entrance Conference: The audit team conducts an Entrance Conference on the first day of the onsite audit. They will introduce themselves and provide general information about the audit process, billing instructions, DC Municipal Regulations (DCMR) that pertains to the audit. During the entrance conference, the provider should be prepared to introduce key office personnel and provide a tour of their facility. 

 

Onsite Work: The audit team makes copies of necessary documents/information, conducts key staff interviews, and reviews office processes. 

 

Exit Conference: The Exit Conference typically takes place on the last day of the audit. In limited circumstances an Exit Conference may be scheduled several weeks after the onsite audit. The audit lead conducts the Exit Conference with the provider and their key staff. It allows the audit team to ask any further clarifying questions and to discuss what the next steps in the audit process are with the provider. 

 

Post Onsite Visit: Upon completion of the onsite visit the provider can expect the review of medical and financial records to take 2-6 months depending on the nature and size of the review/audit. Any records still missing will be requested in a post-audit follow-up letter. The provider is required to mail any missing records to the Division of Program Integrity within 30 days of that letter.