Healtcare compliance risk audit
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Transcript of Healtcare compliance risk audit
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Medical coding auditContract performance auditAR auditDenial prevention auditCompliance audit
A thorough revenue cycle audit should consist of…
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1 Coding Report A dashboard for better coding practices
Your coding report should:
Lists out CPTs, DRG/HCC/APC and the code auditor’s accuracy ratings
Surface the dollar differences spotted between payer contracts and reimbursed codes
Give clear recommendations for remediation based on audit goals
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2 A complete audit of contracts Seal the cracks
The contract audit report should consist of a detailed payer matrix
It should list out various contract elements
Offer data that will help in payer contract negotiation leverage
3 point checklist:
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3 AR audit- Know the story behind the numbers
Know what your AR audit report should consist of:The AR management audit report should examine historical AR valuation activities
The AR auditing team should clearly evaluate current AR reserve estimates
A concise AR audit report helps revenue cycle managers to identify positive and negative AR trends
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4 Denial audit- Because data matters…
Here’s what to look for in your denial audit report:
The denial audit should help you to increase denial management efficiency
It should categorize denials by denial code/payer/dollar value and other vital denominators
Determine the reasons behind untimely follow-ups
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5 Compliance audit Mitigate compliance risks
The compliance auditors should perform risk assessment checks and determine the level of risk
Check compliance with internal policies/payer guidelines and federal regulations
Audit and report the highest risk areas
Know what your Compliance Auditor should do:
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