Choosing a Qualified External Auditor

by Peggy Stilley, CPC, CPC-I, COBGC

When hiring an auditor for your practice, consider the following:

Is the individual or entity credentialed? Verify credentials with the entity issuing the credentials. Verify that the organization issuing the credential holds a reputable standing in the medical community.

Sanctions and Liability: Check potential auditors against the Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) list of individuals who have been sanctioned or listed as excluded.

Experience and References: Request that the auditor supply references from past clients and examples of auditing work they have performed. Call the references to verify information and request input on the auditor’s overall experience.

Certified Professional Medical Auditor

You might also consider using an auditing organization or firm. Request the same credentialing and experience criteria from the auditing entity. It would also be appropriate to determine if a background check was performed by the entity before hiring the individual auditor, which would include the following:

  • Did they verify credentials?
  • Did they check the CMS and OIG list?
  • Was an auditing test required before hire?
  • Do they perform periodic evaluations?
  • Who will oversee the work being performed?
  • Is the auditor certified? If yes, by whom?

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