STEP-BY-STEP

Preparing for an SUD audit

What to expect during an SFDPH BHS Compliance SUD audit.

This is a description of the process of an SUD audit. All timelines are approximate. If you have any questions, please contact your lead auditor

1

Receive an audit notification

Time:~30 days prior to start of the audit

You will receive an audit notification from the lead auditor for your program approximately 30 days prior to the start of your audit. This will be directed to the Program Manager that we have on file. This notification will include the list of services that we will be auditing. Please acknowledge receipt of this e-mail within two days.

2

Prepare service files

Time:Receipt of notification to ~7 days prior to the start of the audit

You will need to prepare files for the services that have been selected. Files should include the following documents that will cover the date of the selected services:

Outpatient, Intensive Outpatient, and Residential programs:

  • Diagnosis narrative summary
  • ASAM LOC (for clients admitted within the past year)
  • Problem list
  • Any applicable continuing services justifications
  • Any applicable residential authorizations
  • Progress notes
  • Group participant list

Peer services:

  • The above items
  • Treatment plan

Opioid Treatment Programs:

  • Any applicable continuing services justifications
  • Treatment plan
  • Dosing order
  • Dosing logs, if applicable
  • Progress note, if applicable
  • If the client has been admitted within the past year:
    • Initial assessment
    • Intake physical exam
    • Needs assessment
    • Statement of dependence or addiction
3

Service file pre-check

Time:a few days prior to the start of the audit

Your lead auditor will spot-check your files for completeness and let you know if there are any missing documents.

4

Audit

Time:1-5 days

During this time, your service files will be checked against our audit tool. Once we have completed our audit, we will communicate any deficiencies we have identified.

5

Post-audit

Time:7 days after the completion of the audit

During this time, you will be permitted to submit additional documentation and explain any deficiencies noted. Services that are disallowed must be made non-billable by the provider.

During this time, you are expected to perform a self-audit keeping these deficiencies in mind, and to make any services detected non-billable.

You may request an exit conference during this time by contacting your lead auditor.

6

Audit report

Time:Within 2 months of the completion of an audit

A report will be issued by the Compliance Officer.