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To stay in compliance & profitable it is imperative that healthcare organizations conduct regular audits. This is the most important lesson learned by CFOS & practice managers in 2016.
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Here’s what 2016 taught healthcare CFOs about revenue management
A thorough revenue cycle audit should consist of… Medical coding audit Contract performance auditAR auditDenial prevention auditCompliance audit
1 Coding Report A dashboard for better coding practices Your coding report should: Lists out CPTs, DRG/HCC/APC and the code auditor’s accuracy ratings Surface the dollar differences spotted between payer contracts and reimbursed codes Give clear recommendations for remediation based on audit goals
2 A complete audit of contracts Seal the cracks 3 point checklist: The contract audit report should consist of a detailed payer matrix It should list out various contract elements Offer data that will help in payer contract negotiation leverage
3 AR audit- Know the story behind the numbers Know what your AR audit report should consist of: The AR management audit report should examine historical AR valuation activities The AR auditing team should clearly evaluate current AR reserve estimates A concise AR audit report helps revenue cycle managers to identify positive and negative AR trends
4 Denial audit- Because data matters… Here’s what to look for in your denial audit report: The denial audit should help you to increase denial management efficiency It should categorize denials by denial code/payer/dollar value and other vital denominators Determine the reasons behind untimely follow-ups
5 Compliance audit Mitigate compliance risks Know what your Compliance Auditor should do: The compliance auditors should perform risk assessment checks and determine the level of risk Check compliance with internal policies/payer guidelines and federal regulations Audit and report the highest risk areas
