Updated on: April 3, 2013

Bill and They Will Come! Real-World Experience Revealed

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Original story posted on: April 1, 2013

Real-world experience and lessons learned are your most valuable resources when evaluating health information technology vendors and outsourced service providers. Whether it's the latest iPhone application, a debt collection service or recovery audit management software, gathering feedback is one of the simplest ways to measure a product's strengths and weaknesses.

Vendors also use customers' hands-on experience in the field to continually improve products to meet real-world challenges. As an example, HealthPort gathers customer and focus group feedback to fine-tune our audit applications, develop new features and bolster service offerings. One customer, Dawn Crump, former network director of audits and compliance at a regional healthcare system in Missouri, recently joined our ranks. I sat down with Dawn to discuss her real-world challenges, lessons learned and 2013 predictions for audits. Here is what she said.

What were your biggest challenges managing audits?

I would say that the two biggest challenges are the same for all providers: being able to juggle all the different types of audits and incoming communications, and being able to financially reconcile the audits with findings. The revenue exchange and identification on post-payment audit denials in the remittance advice is cumbersome at best. A strong combination of people, processes and technology is the only way to manage audits successfully. And even with every piece in place, there are days when audit management is still a three-ring circus!

Who were the most prevalent audit entities you dealt with, and what were the volumes like?

The Region D RAC, HDI, was by far our biggest requester, with nearly 600 for the region every 45 days. We used a comprehensive audit management software application to track our MACs, QIO, CERT and any other type of government audit we received for the region's hospitals.

Can you talk about staffing for audit management, and any efficiencies you were able to gain?

We managed the audit program for our six hospitals in a central location with approximately four FTEs. This included data entry, database QA/reporting, and reviews and appeals. HIM managed the view-and-approve, and our outsourced release of information (ROI) vendor processed the releases.

Early on in the RAC program, we recognized the connection between HIM's ROI process and centralized audit management. Using the outsourced ROI vendor to process audit requests enabled us to respond in a timely and effective manner to auditors and to be adaptive to the changes that are constantly happening.

Finally, we were aligned with our physician advisors, compliance, case management, HIM, business office and finance departments through reporting and process improvement efforts.

What types of trends did you notice during your tenure?

The biggest trends are what most providers are facing today — short-stay medical necessity denials and the issues that revolve around appealing those denials.

What are your predictions for 2013?

I predict a lot more audit activity, and more delays with the appeals process. I don't think any providers are immune to audits. I see growth in Medicaid and commercial and managed care plans. As I've said in the past, "If you bill it, they will come" — my own take on the famous Field of Dreams quote. But for a provider, it's more of a nightmare.

Welcome to our team!

Thank you for your insights, Dawn, and welcome to the HealthPort team. In coming months, Dawn will continue to share her advice, experiences and insights regarding audit management. Stay tuned to learn about new ideas, innovative approaches and stalwart best practices to manage the 2013 audit deluge.

About the Author

Lori Brocato is director of audits at HealthPort. With more than 15 years experience in healthcare technology, Lori serves as HealthPort's resident government and third-party audit expert, sharing educational information and best practices with healthcare facilities via webinars, media interviews and industry articles. Additionally, she is the AudaPro product manager for HealthPort and authors her own blog, Audit Insights, on the HealthPort website.

Contact the Author

Lori.Brocato@healthport.com

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