Resource Library-Making the Most of Compliance Audits & Findings

Video Transcription

Video Summary

Megan Weaver (VP of Compliance, Quality, and HIM) and Dr. Lisa Barker (CMO) from Gulfside Healthcare Services explain how to use compliance audits and findings to strengthen continuous readiness. They differentiate <strong>surveys</strong> (on-site, every few years, focused on Conditions of Participation and care quality) from <strong>audits</strong> (often off-site, unpredictable, focused on Conditions of Payment, eligibility, signatures, timeframes, and claim support). They describe common audit types—MAC Targeted Probe and Educate (TPE), ADRs, SMERC, RAC/UPIC, CERT, and OIG—and emphasize tracking denial codes and trends.

A major theme is creating a culture where clinicians document “as if defending it before a judge.” Gulfside uses Local Coverage Determinations (LCDs), functional status/ICF concepts, comorbidities, and standardized templates so auditors can easily see consistent, comparative change over time.

They present the <strong>MARC model</strong>—Medications, Assessment, Reconcile plan of care, Closing communication—as a unified workflow and documentation structure that supports quality goals (including CAHPS language) and audit defensibility.

Finally, they recommend treating audit findings as improvement opportunities: perform root-cause analysis, build internal monitoring tools based on auditor document request lists, correct system-wide processes (not single charts), update policies, and deliver ongoing role-specific education through strong collaboration between compliance, quality, and clinical teams.

Asset Caption

Speakers: Megan Turby Weaver, M.S.Ed, CHC, CPHQ, Lisa Barker, MD, HMDC, FAAHPM

In today’s world audits are an unavoidable part of operating a healthcare agency. These audits come from all types of reviewers: the Federal Government, Medicare Administrative Contractors (MACs) and State Agencies. While audits are different from surveys, agencies can use similar ‘survey readiness’ concepts and tools to make the most of compliance audits and their findings. Since compliance and quality overlap so much, it is critical that there is a way to share opportunities identified through compliance audits with clinical and quality leaders. In this session you will learn about the difference between audits and surveys, the key focus points of audits, ways to prepare for audits, and how to identify quality process improvements within the auditing results.

Meta Tag

Competency Tag RA1

Competency Tag Description Operationalize processes to support compliance with regulations and standards.

Domain Tag Regulatory and Accreditation

Keywords

healthcare compliance audits

continuous readiness

Conditions of Participation vs Conditions of Payment

Medicare audit types (TPE ADR SMERC RAC UPIC CERT OIG)

denial code trend tracking

clinical documentation defensibility

Local Coverage Determinations (LCDs)

MARC model (Medications Assessment Reconcile Closing)

root-cause analysis and internal monitoring tools