COMPLIANCE OFFICER
Compliance Officer:
First 3 Weeks
Onboarding plan for compliance officers covering audit risk baseline, coding accuracy monitoring, NCD/LCD tracking, and payer policy change alerts.
Week 1
Know the regulatory landscape
Anchor on the active rules, coverage determinations, and updates that shape your audit posture.
Read
Regulatory Intelligence
Proposed and final rules with operational impact summaries.
Reference
CMS Coverage Updates
Weekly digest of CMS coverage changes and policy releases.
Reference
NCD Tracker
Active National Coverage Determinations with effective and revision dates.
Reference
LCD Tracker
Local Coverage Determinations indexed by MAC jurisdiction and topic.
Week 2
Build compliance checklists
Standardize the pre-submission and pre-authorization reviews that prevent audit findings.
Save
Clean Claim Checklist
Pre-submission verification covering coding, modifiers, and NCCI edits.
Save
Prior Auth Checklist
Three-section checklist that documents PA decisions for audit defense.
Reference
Modifier Quick Reference
Modifier definitions and the documentation each one requires.
Reference
Place of Service Codes
POS codes with the facility-vs-non-facility rate implications.
Week 3
Audit-ready operations
Cement the practices and references that hold up under payer audit and OIG review.
Read
Trust & HIPAA
How Upstream handles PHI, audit logs, and access controls.
Read
Payer Behavior Intelligence
Behavior shifts that often precede audit waves and policy enforcement.
Reference
MAC Directory
MAC contacts for audit responses, redeterminations, and provider relations.
Use
NCCI Checker
Validate code pairs against the current NCCI edit table before billing.
Save this and get alerts when it changes.
Free claim review. No credit card.