12 Questions You Need to Ask to Maximize Audit Results

12 questions to ask to get the most out of your revenue integrity and compliance audits

“CFOs and other executives often have little visibility into the results; even those that seriously impact revenue.”

As CFO, the financial health of an organization rests on your shoulders. You identify growth opportunities and watch for payer and government activity that tighten the organizations purse strings. Whether your view is at the 10,000 or 10-foot level, insight into financial opportunity may be out of reach. A healthcare organization’s auditing activities offer opportunities, with serious financial and compliance impacts. Many hospitals today conduct audits surrounding compliance, revenue integrity and/or medical necessity. If your hospital is not currently auditing, the first question you should ask yourself is – What audits should we be doing?  Alternatively if audits are being conducted – What audits are being done that I am not leveraging?

We have found that audit results, more often than not, are not filtered to CFOs and other executives. These audit results provide insight into revenue opportunities (sometimes quite large and from a single chart), gaps in physician and coder training, and proficiency and compliance issues that could lead to serious penalties if left unchecked. Provident recommends challenging yourself and your managers with the following questions to understand and fully leverage your organizations’ auditing landscape:

  • Do I know how many charts are audited per month? By whom?
  • Do I know what compliance issues are found and how they are being addressed?
  • Do I know how audit findings correlate to denials?
  • Do I know how much net revenue per chart is found through these audits?
  • Do we conduct concurrent audits so the revenue is captured before the bill is dropped?
  • Do we conduct retrospective audits, and if so, are they conducted within the re-bill period so I can capture the revenue?
  • Do I know the top DRGs that drive most of our audit findings?
  • Do we constantly retarget our audits to focus on areas of concern and CMS/IG guidance?
  • Do I know how our audit findings correlate to individuals and departments: coders, CDIS, physicians?
  • Do we create audit profiles for each?
  • Do we train our people regularly based on what we are finding?
  • Do we have a formal Revenue Integrity and Continuous Improvement Program?

In answering these questions, you can get the most out of your audit activities; from tracking compliance and regulatory issues to maximizing revenue opportunities.

At Provident, we have a differentiated approach that involves CFOs, hospital executives, management and front line staff. Our Continuous Improvement Program keeps CFOs and hospital executives informed of audit findings and continuous improvement initiatives while our weekly education sessions keep management and front line staff engaged and improving.  Our approach includes:

  • A proactive approach to Revenue Integrity that drives Continuous Improvement
  • Pre-bill or re-bill eligible audit options
  • A comprehensive findings summary for every chart including: coding compliance, documentation findings impacting compliance and revenue, DRG shift capture and analysis, inclusion of findings in audit profiles for coders, CDIS, physicians as applicable, and individualized training examples for each group
  • Audit samples adjusted constantly to focus on areas of concern and CMS/IG guidance
  • Weekly AHIMA CEU Eligible Training sessions for coding and CDIS; as needed/desired for physicians.
  • Quarterly executive review with CFO, HIM, CMO

For more information: Provident’s Revenue Integrity Audits

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