Audits can be time consuming and very costly if not managed properly. Being unprepared is no longer an option. With the expansion and success of the Recovery Audit Contractor (RAC) program audits and increased financial repercussions for audits that have been around for years, audits are ramping up.

Additionally, more and more entities are actively trying to identify improper Medicare and Medicaid payments and recently President Obama stressed the importance of recapture audits. Today, healthcare facilities are being inundated with audits fromMACs and MICs as RAC audits continue to slowly trickle in. Additional audits from CERT, ZPIC and OIG are not far behind, making the need for a systematic and consistent process more important then ever. Missteps related to fulfillment or missed deadlines can be the cause for recoupment and missed opportunity for appeals.

With over 30 years of Health Information Management experience, our extensive knowledge of HIPAA regulation, and interviews with various healthcare leaders, we have developed a list of best practices that we are certain will help you be more prepared for the onslaught of audits coming your way.

We believe that there are eight key actions that you need to put in place to ensure that each and every audit request is optimally managed – education, communication, workflow creation and management, release of information, decision management, appeals management, revenue impact analysis, and the mitigation of future denial issues. Putting a process in place that manages all of these key functions can eventually make audits just another task in your team’s daily activities.

1. Educate Key Stakeholders

Provide your key stakeholders with access to historical information about the various types of audits so they can better understand how each can potentially affect revenue. Introduce them to important websites to increase their level of awareness and understanding of federal and state audits. For additional insight, have stakeholderssign up to receive blog discussions hosted by industry thought leaders and experts. These tools can provide a forum for them to ask specific and targeted questions.

2. Identify a team and schedule regularly occurring meetings

Conside the complete facility impact when creating your team (Health Information Management, Compliance, Revenue Integrity, Finance, Business Office, Medical Staff and Case Management). Audits affect many different areas of the hospital and diverse expertise is needed for optimal management of medical record requests and appeals determination and management. It is important for team members to be accountable and understandeach step of the process. Their responsibilities should be linked to deadlines.

Once your team has been established it is imperative that regular meetings are scheduled to discuss all audit related issues. Meetings should be a forum to share and discuss ideas and experiences as well as to analyze and plan ways to handle known vulnerabilities. Subcommittees are also helpful to address parts of the auditing process like appeals or proactive reviews.

3. Tracking

Create a specific workflow or use database and tracking technology that follows a specific process, to manage audit requests. Keeping track of various audits and their specific due dates is almost impossible to do with a simple spreadsheet.

4. Request letter management process

Proper management of medical record requests is vital to optimal audit management. A process must be put in place that will allow you to quickly launch the release of information activity immediately. An undefined process can cause unnecessary delays which could jeopardize your ability to appeal and avoid recoupment. It is important to realize that the first step in the audit process is effectively responding to requests for medical records. Consider working with a trusted release of information vendor that employs associates who are highly skilled in HIPAA regulation and records processing to manage the request fulfillment.

5. Decision letter management process

The decision letter must be reviewed and processed quickly. Ensure that the letter is attached to the matching records by creating a file that is complete and easily accessible. If you decide to appeal the results of the decision letter, easy access to the complete file significantly reduces the response time.

6. Appeals management process

Appeals must be meticulously tracked to ensure that deadlines are not missed. Concurrent appeals are inevitable and a process must be put in place to carefully track and manage multiple requests, due dates and storage. The use of an automated tool that provides reminders and emails to trigger action is recommended to properly track this complicated process. Look for technology that includes preset audits, is easy to use and that is trusted by your peers.

7. Establish real-time financial management and a dashboard review process

Tracking the dollars at risk is key to understanding the potential impact audits can have on your revenue. Invest in a tool that is easy to read and will provide real-time reports. It should have a dashboard view of dollars at risk as well as dollars won and lost. Data is power. Therefore, it is important to have reporting tools that allow you to review your affected revenue, get a comprehensive snapshot of the financial impact of all audits, identify DRG trends, and more.

8. Establish a process and procedures to prevent denial issues from reoccurring

Conduct internal audits and track and review the results regularly. Use data from internal audits and key reports to validate that any and all vulnerabilities are identified and fixed. Consider working with clinical documentation experts to improve documentation.