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Audits—Paving An Unexpected Path To Success

23 Aug 2016, Posted by Dawn Houston CPC, CASCC in Billing, Healthcare

Too many people hear the word “audit” and believe it signals trouble. But generally speaking, audits are actually a preventative measure, not a reactionary scrutinizing of financial history triggered by tax evasion. In fact, for surgery centers, hospitals and similar healthcare facilities, audits can be key to financial health by preventing denials and optimizing reimbursement.

Take A Look Behind the Curtain

When used as a preventative measure, business and program audits can reveal the following:

  1. Areas of documentation and coding that should be improved to prevent denials and increase production and revenue
  2. Opportunities to better manage ICD-10 implementation, particularly since Medicare has begun denying claims for the use of “unspecified” diagnosis codes
  3. Denial “patterns” that occur due to unclear documentation with regard to certain procedures
  4. Seemingly minimal coding errors that could be responsible for a vast majority of denials (according to the “80/20 rule,” 80% of denials could be caused by 20% of the coding)

In the end, audits are all about improving performance, which in turn contributes to a more consistent revenue stream and stronger bottom line.

Find A Little Piece of Mind

The Recovery Audit Program, managed by the Centers for Medicare & Medicaid Services, exists to identify instances of Medicare overpayment and underpayment to healthcare providers, and in its first three-year period recovered more than $900 million. Those are funds that were taken back from providers and returned to the Medicare Trust Fund.

 

But conducting your own annual or biannual audit (or having in2itive conduct one for you!) can help prevent any potential issues with Recovery Audit Contractors (those who collect on behalf of the recovery program).

So prepare your facility for possible outside audits—conduct your own routine evaluations and remember:

 

  1. Don’t wait for large payments to be recouped to realize what areas need to be improved.
  2. Just because a claim gets paid initially does not mean it was coded correctly and compliantly.
  3. Greater accuracy is needed when coding for a multi-specialty practice due to the wide variety of procedures performed.

 

We’ve said it before and will continue to remind you: healthcare and the associated revenue process changes constantly. Keeping up with evolving standards and best practices takes work and regular internal audits are part of a positive, proactive effort. If you’re ready to get the process underway, contact us at in2itive Business Solutions to make sure your next audit is efficient, thorough and informative.

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