Performing laboratory compliance audits.

Abstract

Billions of dollars are paid improperly each year because of laboratory service billing errors that include services not covered, incorrect coding, lack of medical necessity, and unsupported services. An important part of a laboratory compliance program is the compliance audit. This article discusses barriers to a successful audit, audit skills for the laboratory, areas to cover in an audit, and writing the audit report. Intermountain Health Care (IHC) is an integrated health-care system consisting of 20 hospitals in Utah and Idaho, health plans with 450,000 directly covered lives and contracts to third-party insurance companies covering 500,000 additional lives, and 75 other facilities with 400 employed physicians. Approximately 1,000 of IHC's 23,000 employees work in laboratories.