The Changing Face of Healthcare Auditing
Healthcare Auditing
The COVID-19 pandemic has brought sweeping changes to almost every facet of life. Healthcare services are, logically, some of the most impacted and, as a result, healthcare audits have changed as well.
In March 2020, the Centers for Medicare and Medicaid Services (CMS) suspended the majority of Medicare Fee-for-Service reviews. However, in August, CMS announced those audits would resume.
As a result, healthcare providers should expect to see a near-term rapid increase in audits, which may quickly become overwhelming.
Long-term, the audit forecast is even darker. Because recovery audits are considered a leading profit center for health insurance companies, industry experts are predicting that the new expanded pandemic billing codes are at heightened risk for scrutiny.
During the pandemic, restrictions for billing certain clinical procedures were lifted (e.g., telehealth, remote patient monitoring, etc.). The codes are untested and unfamiliar to billers and coders under these new circumstances, and are expected to trigger a surge in audits. With reduced workforces in place, billers are overworked, exhausted, and mistakes are easier than ever to make.
Get Rid of the Spreadsheets
On the front-end of the billing cycle, the mandated adoption of electronic medical records (EMR) and electronic health records (EHR) has helped the provider to
better manage and access the plethora of patient care information needed to successfully defend themselves against inevitable Recovery and Post-Payment Audits.
While EMR’s/EHR’s are known for their all-inclusiveness on the front-end of the billing system, the complex back-end is left mainly to manual processes and systems like Excel.
RevKeep picks up where the EMR/EHR leaves off: at the point of the post-payment audit. RevKeep has been called an EMR/EHR for post-payment audits.
Be Prepared for Remote Audits
Travel restrictions, personal distancing and the general avoidance of face-to-face meetings have all led to an increase in remote audits. These remote audits will likely continue beyond the COVID-19 pandemic. And, while responding to and defending against post-payment audits is difficult enough, working the process remotely can be even more difficult.
Furthermore, in a busy office, post-payment audits often find their way to the bottom of a pile of to-do’s, heightening the risk of losing (often significant) revenue for the facility. And with so many people working remote, that pile of to-do’s may be located off-site, in someone’s home – out of reach of colleagues that might be able to pitch in before a deadline hits.
Unfortunately, there’s no safety net when the critical deadlines arrive and the stack of audits were forgotten because someone was busy, got sick, or left on vacation.
So, how can a health provider, big or small, proactively prepare for post-payment audits? Because, it’s not ‘if,’ but
‘when’ will they arrive?
Revenue Cycle Management and Compliance Officers tasked with the responsibility of replying and defending these audits can stay on top of ‘the wave’ by implementing systems and processes to ensure oversight of the operation, transparency of their advancement through the cycle, the quality and appropriateness of responses, history of submissions, external vendor / attorney progression, etc.
Organize Remote Patient Monitoring (RPM)
As positive COVID test results and cases continue to increase, providers should expect remote patient monitoring (RPM) to increase as a result. Current guidelines permit providers to use RPM from two to16 days as long as the patient is confirmed to have or suspected of having COVID-19.
In response to pressure from Congress, CMS issued specific COVID-19 guidance around RPM as part of their 221 page “
Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” report. Adherence to these guidelines is sure to receive close scrutiny and carry the potential for more post-pay audits.
More Audits to Come
The current COVID-19 crisis notwithstanding, CMS has resumed post-payment audits. Proactive preparation and planning are key to a provider’s readiness; regardless of when the audits arrive.
RevKeep software is a powerful tool that helps healthcare providers control and better manage post-payment medical audits. Considered to be one of the best defenses a provider has in fighting, managing, and responding to recovery audits.
Click
here to learn more about how RevKeep can help you better manage post-payment audits.
