Risk-based Auditing Software Helps Keep Healthcare Spending Under Control

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The United States healthcare system has undergone tremendous transformation since the 1970s. This is reflected in recent data suggesting a 2,300% increase in healthcare spending between 1970 and 2009.(1) This is partially explained by an increase in the number of governmental rules and regulations which implement strict guidelines for many aspects of care, including medical coding and billing. In many cases, the complexity of these guidelines leads to coding and overbilling issues. Ultimately, these issues bring about increased costs for the healthcare system as a whole, with much of the burden falling back on providers and patients. The solution, says Fi-Med Management, is the implementation of risk-based auditing software, which identifies coding problems early on and helps healthcare organizations avoid costly governmental audits.

A significant portion of these increased costs is attributed to the expansion of healthcare administrator rolls, with explosive growth in the number of people hired to fill such positions. However, a key driver of this expansion is the creation of an unprecedented number of regulations to which healthcare organizations must adhere in order to remain compliant.(2) From 1975 to 2010, the number of healthcare administrators grew by 3,200%, while the number of practicing physicians only grew by 150%.(3)

The increasing number of people needed in order to properly oversee complicated processes such as medical coding is driving healthcare spending across the board. While many organizations strive to remain compliant, they can’t do so without a team of professionals monitoring for mistakes and correcting issues that occur.

Adrian Velasquez, president, CEO and co-founder of Fi-Med Management, says, “Healthcare organizations can help keep costs down by employing technology that gets to the root of issues, especially those concerning medical coding and billing. This kind of technology identifies problems before they become major issues, which helps reduce healthcare spending overall.”Risk-based auditing software, such as Fi-Med Management’s REVEAL/md, makes compliance easier by flagging problems that may lead to overpayments or underpayments. Healthcare organizations can protect their finances by implementing these solutions for all members of their healthcare team.

1.    The Chart that Could Undo the US Healthcare System. Foundation for Economic Education. https://fee.org/articles/the-chart-that-could-undo-the-us-healthcare-system/
2.    The Growth of Administrators in Health Care. Investing Doc. https://investingdoc.com/the-growth-of-administrators-in-health-care/
3.    The rise (and rise) of the healthcare administrator. Athena Insight. https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator.

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