healtcare compliance risk audit

Here’s what 2016 taught healthcare CFOs about revenue management

Medical coding auditContract performance auditAR auditDenial prevention auditCompliance audit

A thorough revenue cycle audit should consist of…

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

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:

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

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

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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