As healthcare payment models evolve, it’s more important than ever to protect your revenue. Yet the number of audits—recovery, government and commercial—continues to rise. The effects of these audits have both financial and human capital implications.
In its semiannual report to congress, the HHS OIG reported that $3.35 billion was recovered in 2015. The first half of the year saw $1.8 billion in take-backs. Compare that to the first half of 2016 where $2.77 billion was recovered. This means that in just the first half of this year, the government has recovered nearly the full amount recovered for all of 2015.
As if that weren’t enough to keep providers awake at night, these audits are requiring significant human capital investments. The time and expertise required to manage audits and appeal processes have become a real burden.
How are providers to overcome this challenge? Data.
“With so much effort expended on audits, how can providers reap a return on their human capital investment? The answer lies in data,” said Dawn Crump, vice president of audit management solutions at CIOX Health, in an article for Health Data Management.
Data—and the ability to analyze that data—is crucial to reducing the financial impact of audits and streamline the workflows and manual processes associated with those audits. Additionally, predicting audits and proactively addressing revenue cycle red flags—rather than reacting to audits—is essential.
In a recent webinar, Ed Reyes, senior compliance auditor from Sutter Health discussed how he has leveraged his data to improve compliance efficiency and proactively prepare for audits.
With self-service analytics, Reyes and his team proactively monitor audit risk, pinpoint the root causes of audits and boost efficiency by streamlining audits and appeals across the organization. “Our department needed to mature our data analytics process from a risk perspective,” said Reyes. “Having the ability to aggregate, analyze and assess data has provided tremendous opportunity.”
Analytics enable Sutter and many others to improve their compliance efforts by:
- Proactively identifying audit target areas to reduce take-backs
- Mitigating audit risk and uncovering opportunities to improve coding and documentation
- Automating the audit and appeal process to increase compliance efficiency
- Improving appeal success by managing appeal workflows, organizing documentation, and managing deadlines
- Maximizing compliance resources and pinpointing claims likely to result in take-backs
- Comparing compliance performance with benchmarking data
- Standardizing compliance through a centralized analytics platform
Data must be actionable to successfully manage compliance efforts. With data analytics, you can regain power—as you reduce both the financial impact and the human capital expense in compliance.