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More than 4,000 Health Information Management (HIM) professionals gathered in Chicago last month for the 84th National Convention and Exhibit, where one of the hottest topics was how to cope with the preponderance of audits by Medicare, Medicaid, OIG, and more. 

According to the American Hospital Association’s (AHA) RACTrac survey, audit activity is on the rise. HIM professionals at AHIMA concurred. According to some attendees, volumes of requests are not only up, they are way up! This is especially true for medically unnecessary and all other complex denials, taxing an organization’s human resources and increasing operational expense.

HIM professionals bear the weight of complex reviews. They serve as the front line for receiving requests, pulling records, reviewing charts prior to submission, producing copies, and ensuring on-time delivery to auditors. All these steps require manual effort, time, and money. “How are you coping with the spike in audits?” was a commonly heard question during educational sessions and in the exhibit hall.

Three Key Concerns for HIM  

Specifically, AHIMA attendees discussed how to better manage audits in three key areas: Processing of requests, identification of duplicate requests, and cost reduction. Here are some of the coping mechanisms we heard during the conference.

Centralize and Automate

Receiving and responding to auditor requests is a huge undertaking for HIM.  In order to cope, many organizations have centralized the audit function across locations, thereby strengthening audit workflow and request processing. With a defined team of audit staff, organizations are better able to coordinate activity and identify duplicate requests. The auditors also appreciate centralization, as they now have one central contact and department, simplifying provider communications.

The use of technology was also mentioned as a way to streamline audit processing while also reducing labor costs. Two types of automation were discussed: Audit management software, and electronic delivery of records. Hospitals that originally managed audits with Excel spreadsheets or Access databases were actively exploring audit management software solutions at AHIMA.

Electronic delivery of auditor requests was another hot topic. Technology is currently available in two flavors: CMS’ esMD project, or a direct portal connection to the payer. HealthPort supports both types of electronic delivery, but was focused on portal connection capabilities at AHIMA.

A direct portal is a single organizational conduit to all audit entities, that can be shared by HIM, the business office, and any other department submitting records to auditors. HealthPort’s government audit solution, HIHPro™, uses a secure electronic connection and delivers end-to-end tracking capabilities for all audit record requests. Using direct portal connections can save up to 50 percent in associated costs, and removes significant amounts of paper from the audit process.

Eliminate Duplicate Work

As mentioned above, software integrated into a providers’ workflow was noted as the best practice to identify duplicate requests across all auditing bodies. Second-generation audit management applications log, track, and manage all types of audits, not just RAC. Whether the delivery mechanism is paper or digital, duplicate work must be avoided at every turn. Audit management software in conjunction with centralization helps.

Bolster Up-Front Prevention

Attendees also discussed the need to bolster audit prevention up front, through stronger clinical documentation improvement (CDI) programs. Medical necessity denials and other complex denials are often circumvented if documentation within the record is complete and accurate. The mantra of improving clinical documentation as a first step in reducing denials and mitigating audit risk was repeated at every booth and in every session.

Physician Practices Get in the Game

Finally, attendees were abuzz about physician practices. Programs are being expanded into ambulatory settings, and auditors are requesting physician office records in addition to hospital charts. There is much to learn about the expansion of audit programs into physician practice settings. Suffice it to say it is coming, and providers are beginning to prepare.

Next Year in Atlanta

AHIMA is a conference everyone involved in audit management should attend. The confluence of audit program expansion and industry change shows no sign of slowing down. And this doesn’t even include our biggest mandate: ICD-10! 

Save the date and plan to join me at the 2013 AHIMA convention in Atlanta, HealthPort’s own back yard!

About the Author

Lori Brocato, HealthPort Audit Product Manager, has over 16 years of experience in the healthcare technology industry creating product lifecycle plans and executing product strategies. Ms. Brocato frequently serves as an audit expert sharing audit management trends and best practice guidelines as a regular presenter for industry events and webinars.  She is the author of HealthPort’s audit Insights Blog and provides expert input for many trade publication articles each year. Ms.Brocato holds the distinction of being RAC-certified by the Medicare RAC Summit and is a member HIMSS, HFMA, and AHIMA.

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