RESUMO
The meteoric rise in the number of audit requests threatens to exacerbate communication problems between payers and providers about medical record audits. Providers should understand why payers are requesting records and what information they need, and payers should strive to provide the most accurate possible information about their requests. Education can help both sides of the audit equation to improve processes and reduce payer-provider friction.
Assuntos
Pessoal de Saúde , Revisão da Utilização de Seguros , Relações Interinstitucionais , Medicare , Estados UnidosRESUMO
Centralized audit management and lean audit processes are quickly becoming a necessity to contain rising costs. Organizations adopt these approaches to improve productivity, reduce operational expense, and mitigate risk through denial prevention. Centralized teams will be in position to conduct presubmission reviews of all documents before they go out to auditors and to capitalize on technology and data to reduce costs.
Assuntos
Eficiência Organizacional , Auditoria Financeira/economia , Gestão da Qualidade Total , Controle de Custos , Economia Hospitalar , Medicare , Estados UnidosRESUMO
2011 will bring a rise in audit threats facing healthcare organizations. Zone program integrity contractor audits, which can look back 10 years, are potentially most onerous. Providers should take a proactive approach that works in all audit situations. Implementing a clinical documentation improvement program and focusing on physician education are key to reducing revenue losses.
