By Barbara Carr, RHIA
In today’s ever-evolving healthcare landscape, navigating the challenges posed by increasing payer audits and denials demands a proactive and expertly crafted approach to claims accuracy and compliance. To effectively tackle these challenges, healthcare organizations must adopt an integrated solution that tracks the entire audit process from initial request receipt to denial and appeal resolution. This comprehensive and systematic approach is vital for mitigating the financial risks associated with payer audits and ensuring sustained success.
Herea are some top reasons you should focus on optimizing your payer audit management process:
Enhanced Efficiency and Organization: The integration of all audit-related information and documents into a centralized system streamlines the entire audit process. This eliminates manual tracking, reduces administrative burdens, and safeguards against missing critical deadlines.
Timely Response to Audits: By diligently tracking audits from the moment of request, Release of Information Specialists (ROIS) can promptly respond to audit inquiries, reducing the likelihood of delayed or incomplete responses that may lead to denials. An integrated system also provides valuable data on the status of audits, ensuring that deadlines are met.
Improved Visibility and Transparency: Payer audits involve multiple steps and stakeholders. A comprehensive system offers real-time visibility into the audit status, empowering coding teams, clinical documentation teams, compliance officers, and management to stay informed about audit progress, denials, and appeals.
Identification of Patterns and Trends: With an effective audit management process, organizations can identify patterns and trends in coding audits and denials. Analyzing this data enables a proactive approach to address root causes and prevent future denials, ultimately leading to improved financial outcomes.
Compliance and Regulatory Adherence: Adherence to coding and billing regulations is critical for healthcare organizations. Your audit tracking solution should be built to ensure systematic compliance with these requirements.
Effective Appeals Management: Tracking audits through the denial and appeal process is essential for efficient appeals management. With proper audit management technology, an audit team can identify common reasons for denials and develop targeted strategies to overturn them.
Data-Driven Decision Making: Comprehensive reporting capabilities (beyond spreadsheets) enables an audit team to gather data on audit outcomes, denials, and appeal success rates. Armed with this critical data, financial teams can make informed decisions regarding coding practices, training needs, and resource allocation.
Proactive Risk Mitigation: Vigilant monitoring of audits and denials allows organizations to proactively address potential compliance risks and coding errors. This approach reduces the financial impact of denials and minimizes the risk of audits leading to legal or regulatory issues.
Verisma Claims Audit Manager
Verisma recently announced the launch of Verisma Claims Audit Manager (VCAM) in collaboration with Office Ally. VCAM connects ROI with business office in an end-to-end solution that offers unmatched enterprise reporting capabilities.
A comprehensive approach to payer audit management supported by advanced technology is essential for healthcare organizations to achieve sustained success in an increasingly complex healthcare landscape. By focusing on optimizing this process, organizations can stay ahead of payer audits and denials, safeguard financial stability, and maintain a commitment to delivering high-quality patient care.