We can’t know the specific curveballs auditors may throw at us. But we do know that those curveballs come. That’s why it’s so important that everyone be ready.
The biggest areas of risk can be anticipated. There are patterns that auditors go after. They target issues around medical necessity, pharmacy and chargeable supplies to name a few vulnerabilities.
If you’re not validating that your health system’s documentation and data are current, complete and correct, you’re going to strike-out and lose all reimbursement on many claims.
To stay ahead of the curve, verify that your claims are optimized for appropriate earned reimbursement.
To achieve this requires planning and organizing for revenue integrity. In other words, healthcare systems need to have in place: efficient communication processes among people with clearly defined decision-support responsibilities who are supported by effective technology.
Compliance requirements and data change all the time, keeping up is challenging. With the right support, knowledge base, and tools, healthcare systems can keep up successfully. By locating recurring errors and addressing them upstream – before they become costly patterns – claims can be submitted right the first time, which reduces exposure to denial and pre-payment audit risks.
Once an audit curve-ball gets thrown your way, the timer is ticking. You must be ready for additional documentation requests (ADRs) so that the quick deadlines can be met. This begs the questions:
- Is electronic submission of medical documentation (esMD) available to save your team’s valuable time in responding to ADRs?
- Can leadership get the performance indicators they need to decide how to proceed with various audits in a timely manner?
- Can you look up patient information in real-time? And, do your people still have to manually input details from 837 claim submittal and 835 remittance advice transactions into your audit management system?
These vital aspects of your audit management readiness should be explored as soon as possible.
Share with us your findings and tips about what your organization has found effective in the quest for clean compliant claims and efficient audit management.
And attend the Craneware Benchmark Series: Key Indicators of Revenue Integrity Excellence to understand how well your organization is performing against Craneware standards and, equally importantly, gather step-by-step best practices to minimize compliance risk and optimize financial performance.