The Value of an Audit
By Kelly Lanning, Director of Revenue Analysis, Detroit Medical Center
Healthcare relies on audits to ensure they remain compliant and assist with identifying potential risks. Is your organization prepared?
Audits occur on many different levels and have different areas of focus. External audits can be performed by many different teams. The following are the most identifiable audits within healthcare:
- Commercial Payer Audits
- Federal Government Audits
- Third-Party Expert Audits
- Compliance Audits
- Coding and Documentation Audits
- Quality Assurance Audits
- Privacy and Security Audits
- Pharmacy Audits
- Internal Audits
Audits are performed by evaluating comprehensive transactions. This is a great way to discover areas of opportunity. Processing these requests can seem daunting due to the complexity and volume of requests. Preparing your team to meet the expectations before starting the audit is highly impactful.
It takes a village to satisfy all of the requirements of an audit. Specific areas with revenue streams are typically the primary focus during an audit. This can include supplies, adjustments, cash posting, pharmacy, capital, and real estate, to name a few. Many areas within your organization will be called upon.
The first step in completing an audit successfully is identifying the champion at your organization. This person will be the primary contact for receiving and submitting requests from the audit team. This will decrease confusion and promote consistency when reporting back to the auditors.
Keeping a working spreadsheet to track outstanding items and document completed tasks is pivotal to your team’s success. This document should be a view only for all team members but should only be edited by your champion. Once again, creating consistency in this process will allow for a more strategic approach.
As documentation is sent and received by the champion, it is important to ensure the request is fully understood before submitting the response. Do not be afraid to ask clarifying questions. Providing too much information can lead to more scrutiny and additional requests. Timely responses are necessary because this could potentially disrupt the end result.
After receiving your final scores, it is imperative to create action plans to improve in the areas with low scores. During this reconciliation, it is essential to communicate with the teams that were affected by the “needs improvement” scoring. Training and education are often the correct discipline to reconcile these deficiencies. Developing policies and procedures post audit will give the organization guidelines on properly adhering to the corrective action. Constructive feedback can provide the team with tools to develop standardization and quality metrics. Consistent follow-up and tracking of the remediation plans will provide employees with measurable results.
Audits can assist revenue cycle management (RCM) in finding discrepancies in workflow. Understanding that the audits are done using random accounts for specific timeframes will provide valuable data and greater optimization.
Publishing the results of an audit can provide patients with transparency with quantitative results and projected resolution. This forward-thinking can build trust within the community. Increasing positive patient experience can be driven by audit results.
Audits will allow the team to create compliance with regulatory requirements. Audits help healthcare facilities stay aligned with industry standards and ultimately mitigate risk.
