Avoid Costly Audits
The Office of Inspector General (OIG) recommends internal audits for healthcare providers because they can be beneficial in enabling the organization to:
- Improve clinical documentation
- Improve provider coding
- Identifying where provider education is needed
- Improving the overall billing processes.
In addition, internal audits are invaluable in improving reimbursement and gaining valuable insight for quality improvement initiatives.
During RAC Audits
RAC audit program collections are having a significant negative impact on the profitability of hospitals. RAC audits are ramping up after a period of no audits during the COVID-19 pandemic.
Received No Education
According to this RAC survey, 59% of hospitals indicated they have not received any education related to avoiding payment errors from CMS or its RACs.
Reported increased administrative costs
RAC audits are resource intensive. They require time to pull the required documentation and make appeals. In 2012, 55% of hospitals reported administrative cost increases associated with audits.
Audit risk does not have to be a challenge for your organization!
In June 2021, CMS indicated it intended to audit claims filed during the COVID-19 pandemic but held off on implementing that plan. Now, CMS appears to be moving forward with these audits.
The agency is quickly expanding audit programs, and providers need to understand how that will unfold. While CMS might have said that it would resume claims audits gradually, it’s now shifting into a higher gear.
It’s not just Medicare expanding its audits; Medicaid and managed care programs are ramping up their claims audits. As a result, audits and claims appeals that have been dormant for a year or longer are suddenly active. In addition, these organizations are initiating new audits for the first time in over a year.
And finally, besides Medicare and other payers audits, providers must face compliance challenges and potential audits from pandemic relief programs, such as the Provider Relief Fund.
How does Audit Risk Assessment work?
Value for Your Organization
The Audit Risk Assessment (ARA) program addresses your audit concerns and comprehensively analyzes your risk exposure. For example, it looks at provider coding and identifies providers that are over coding and placing you at risk.
ARA lets you know where to act to avoid a costly audit. There are no IT resources or EMR integration required. Just provide data to Fi-Med, and our experts will deliver everything you need to proactively address concerns and mitigate risks.
Understand:
- How do we stack up nationally against our peers?
- What is the overall compliance/audit risk, and what is our financial exposure?
- Which specialties have the highest risk exposure?
- How many and which providers have the highest compliance/audit risk?
- Which providers need counseling and education to reduce their Compliance/Audit risk?
- Which providers should we start with first to reduce or risk exposure?
- What are the codes at issue?
Audit Risk Assessment Benefits
ARA has other benefits besides providing a detailed analysis from which you can take action to minimize current compliance issues/audit risks, including:
Overall staff efficiency is DRAMATICALLY enhanced
Reduce risks quickly without increasing your workload. Not only do you know where to act, your providers with the most risk are identified and the percentage they need to improve to avoid audit risk is known.
enhance provider training and knowledge
Identify Potential Revenue Resources
Internal audits are invaluable for improving reimbursements and gaining insight for quality improvement initiatives. Our smart technology tool, revealMD, is used for Audit Risk Assessment and Revenue Value Assessment.
Deliverables
Our Audit Risk Assessment assess both Fee for Service and Value-Based Care coding risk.
Assessment of 100% of Your Providers
Each provider is assessed on their coding practices.
Assessment of all Billing for All Payers
Billing is reviewed for over coding.
Analysis of Over Coding
Identify increased audit risks associated with over coding.
Data & Graphical Support for Provider Education
Information to educate providers and avoid future risk exposures.
Discussion with experts
Conversations with Fi-Med consultant to discuss findings.
Comprehensive Review Analysis
Includes all deliverables, recommendations, and a proposal for an ongoing audit risk assessment retainer.