Post-Payment Problems in The Port City

A major Southern hospital system is confronting the challenge of post-payment audits.

EDITOR’S NOTE: RACmonitor, in association with RevKeep, is producing a three-part series on additional documentation requests (ADRs) that arise post-payment. In this, the third article in the series, Chuck Buck interviewed Jennifer Bartlett, coordinator of clinical audits and disputes at Infirmary Health System.

Just 150 miles from the Big Easy of New Orleans is what’s known as The Port City: Mobile, Alabama, where Infirmary Health System has existed for 111 years. Unbeknownst to many, Mobile, not New Orleans, has the oldest organized annual Mardi Gras celebration in the country – although the post-payment audits Infirmary has been dealing with lately are anything but a party.

Spend a couple of minutes with Jennifer Bartlett, coordinator of clinical audits and disputes at Infirmary, and you can quickly grasp the challenges she faces in her role of being the gatekeeper for such matters.

“We are a large organization with multiple facilities, Bartlett wrote in an email to RACmonitor. “They (post-payment audits) require tedious review prior to submission of records.”

And, depending on the service line, this could span multiple departments, Bartlett added. She also noted that once the clinical audits are returned from the auditor – think Medicare’s Recovery Auditor for her region, which is Cotivity – with any findings, then this again requires possibly multiple employees, such as those in coding, clinical documentation integrity (CDI), the physician office, and health information management (HIM), in order to craft the discussion leading to the appeal process. Managing this entire process is very cumbersome.

At the present time, Bartlett said her health system is using Epic for their electronic health record (EHR) system. They are trying to use it to handle the post-payment audits (despite it not being designed for this), which in of itself is bringing about a number of challenges for her team.

“This is due in part to Epic having so many pieces and programming requirements,” Bartlett explained. “It makes development of robust, role-specific work queues very difficult for the information and management that we require across the post-payment audit spectrum.”

Adding more salt to the wound, Bartlett acknowledged that there has been an increase in post-payment audits. She also said she is challenged by the COVID-19 backlog as a result of the public health emergency (PHE) – so much so that they have had to file an 1135 waiver for a time extension.