HealthPort recommends eight steps for hospitals to manage audits from recovery audit contractors and other outside agencies.
1. Educate stakeholders. To help members for your organization understand the process, give them information on the various types of audits and provide links to websites that could teach them more. Have them sign up for blog discussions hosted by experts who can answer specific questions.
2. Have a team to oversee process. Assemble an in-house team to oversee the auditing process. Include people from all areas impacted by an audit, including health information management, compliance, revenue integrity, finance, business office, medical staff and case management. Their diverse expertise will be needed to manage medical record requests and appeals. Team members should be accountable and understand each step of the process. Their responsibilities should be linked to deadlines. Make sure the team meets regularly to share ideas and experiences, identify vulnerabilities and plan ways to handle them. Consider forming subcommittees to address parts of the auditing process such as appeals or proactive reviews.
3. Track audit requests. Using just a spreadsheet is not enough to keep track of audits and specific due dates. Use database and tracking technology that follow a specific process. Consider using tested software that tracks and trends information. Find an intuitive technology to help look for patterns and prevent future recoupment. Such a system should make it easy to frequently update and share information.
4. Create request management. The first step in the audit process is effectively responding to requests for medical records. An undefined process creates unnecessary delays, jeopardizing your ability to appeal and avoid recoupment. Proper management of medical record requests is vital for optimal audit management. You should be able to quickly launch release of information activity. Consider hiring a trusted release-of-information vendor knowledgeable in HIPAA regulations and records processing to manage request fulfillment.
5. Set up process for decision letters. Should you decide to appeal a decision letter, easy access to the complete file will significantly reduce response time. Have a method to review and quickly process the decision letter. To make sure the letter is matched to the correct records, create a file that is complete and easily accessible.
6. Track appeals. You should be able to meticulously track appeals to ensure deadlines are always met in this complicated process. Since concurrent appeals are inevitable, put a process in place that carefully tracks and manages multiple requests and due dates and handles storage. Use an automated tool providing reminders and e-mails to make sure action is taken. Choose a technology that includes preset audits, is easy to use and is trusted by your peers.
7. Establish real-time financial management. Tracking the money at risk will help you understand the impact audits might have on your revenue. Select a tool that is easy to read and provides real-time reports. It should have a dashboard view of money at risk and what has been won and lost. Reporting tools should help you review affected revenue, get a comprehensive view of the financial impact of audits and identify DRG trends.
8. Create a process to stop future denials. Conduct internal audits and review the results regularly. Use data from internal audits and key reports to assure that vulnerabilities have been identified and fixed. Bring in clinical documentation experts to improve documentation.
Find out more about HealthPort.
Read more coverage of RACs:
- 5 Conclusions on First Full Year of RAC Implementation
- 5 Issues to Consider When Appealing a RAC Decision
- RACs Can Request Claims Not on Approved List
1. Educate stakeholders. To help members for your organization understand the process, give them information on the various types of audits and provide links to websites that could teach them more. Have them sign up for blog discussions hosted by experts who can answer specific questions.
2. Have a team to oversee process. Assemble an in-house team to oversee the auditing process. Include people from all areas impacted by an audit, including health information management, compliance, revenue integrity, finance, business office, medical staff and case management. Their diverse expertise will be needed to manage medical record requests and appeals. Team members should be accountable and understand each step of the process. Their responsibilities should be linked to deadlines. Make sure the team meets regularly to share ideas and experiences, identify vulnerabilities and plan ways to handle them. Consider forming subcommittees to address parts of the auditing process such as appeals or proactive reviews.
3. Track audit requests. Using just a spreadsheet is not enough to keep track of audits and specific due dates. Use database and tracking technology that follow a specific process. Consider using tested software that tracks and trends information. Find an intuitive technology to help look for patterns and prevent future recoupment. Such a system should make it easy to frequently update and share information.
4. Create request management. The first step in the audit process is effectively responding to requests for medical records. An undefined process creates unnecessary delays, jeopardizing your ability to appeal and avoid recoupment. Proper management of medical record requests is vital for optimal audit management. You should be able to quickly launch release of information activity. Consider hiring a trusted release-of-information vendor knowledgeable in HIPAA regulations and records processing to manage request fulfillment.
5. Set up process for decision letters. Should you decide to appeal a decision letter, easy access to the complete file will significantly reduce response time. Have a method to review and quickly process the decision letter. To make sure the letter is matched to the correct records, create a file that is complete and easily accessible.
6. Track appeals. You should be able to meticulously track appeals to ensure deadlines are always met in this complicated process. Since concurrent appeals are inevitable, put a process in place that carefully tracks and manages multiple requests and due dates and handles storage. Use an automated tool providing reminders and e-mails to make sure action is taken. Choose a technology that includes preset audits, is easy to use and is trusted by your peers.
7. Establish real-time financial management. Tracking the money at risk will help you understand the impact audits might have on your revenue. Select a tool that is easy to read and provides real-time reports. It should have a dashboard view of money at risk and what has been won and lost. Reporting tools should help you review affected revenue, get a comprehensive view of the financial impact of audits and identify DRG trends.
8. Create a process to stop future denials. Conduct internal audits and review the results regularly. Use data from internal audits and key reports to assure that vulnerabilities have been identified and fixed. Bring in clinical documentation experts to improve documentation.
Find out more about HealthPort.
Read more coverage of RACs:
- 5 Conclusions on First Full Year of RAC Implementation
- 5 Issues to Consider When Appealing a RAC Decision
- RACs Can Request Claims Not on Approved List