1 / 13

Let’s talk about audits

Let’s talk about audits. HomeTown Health. Topics. Background Trends Financial risks Discovery Audit Management Support services Next steps. Background. Healthcare providers face the challenge of complying with an alphabet soup of audits RAC

kenna
Download Presentation

Let’s talk about audits

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Let’s talk about audits HomeTown Health

  2. Topics • Background • Trends • Financial risks • Discovery Audit Management Support services • Next steps

  3. Background • Healthcare providers face the challenge of complying with an alphabet soup of audits • RAC • MAC • MIC • PERM • ZPIC • RAC DME • Medicaid RAC • HEDIS • DOJ • Plus • Commercial Payor audits Government Alphabet Company Confidential

  4. Audit relationships Company Confidential

  5. Audit trends • Increasing type and frequency • RAC activity increased almost 30% in Q1 vs. Q4 2011 • i.e. Medicaid RAC, Medicare RAC DME part D • Increase in number of providers audited • Increased expenses to manage audits • 55% of reporting hospitals spent $10K or more in Q1 on RAC • Report average outside services spending of $75 + per audit • Increased burden on staffing • Reporting hospitals spend 4 hours or more on each audit • 26% added staff to manage audit load Company Confidential

  6. Financial Risks • Increased risks to healthcare providers financials • Q1 RAC denials $741 million • 2X increase vs. Q4 2011 • One-third of audits uncovered inaccuracies • 59% of reporting hospitals said no education on issues or errors from CMS or RAC contractor Company Confidential

  7. Company Confidential

  8. Audit Management Support • Discovery offers specialized services to support your audit efforts • Audit requests are not standard ROI requests • Greater financial risk • Special handling • Expertise and experience • Expediting & tracking • Electronic delivery and confirmation (see next slide) • esMD for eligible government audits • Includes: RAC, MAC, PERM, CERT • Detailed reporting Company Confidential

  9. Company Confidential

  10. Audit Management Support • Our program for audits includes • Field review of request or claim letter • Identify due date • Prioritization • Assembling relevant requested medical records • Scan paper records • Extract electronic records • Preparation and presentation of .pdf file for internal provider review and approval (if required) • Upload to Discovery for special handling • Second review request or claim letter • Re-validate due date • Processing, data entry, and QC Company Confidential

  11. Final review at Audit desk • Trained Audit expert • Establish / confirm distribution method • esMD or Print • Distribution via • Trackable UPS delivery or esMD if eligible • On-line access through StatusNOW • Detailed reporting • Confirmation of receipt esMD • CMS • Audit contractor Company Confidential

  12. Audit Management Support • Cost effective • Collect first from requestor where possible on commercial payor audits • Pricing model • $0.12 per page • $5.00 per claim esMD charge (where applicable) • Shipping and handling at cost • Getting started • Create Statement of work • Outline roles and responsibilities • Amend agreement Company Confidential

  13. Questions RELAX ! Company Confidential

More Related