operation management in cutler bay

Using Operation Management Audits To Improve Compliance In The Healthcare Industry

Health plan audits are a necessary part of making sure that the system runs well. A dual effect is produced for hospitals and health systems by operation management audits- they simultaneously produce financial blows as well as potential lessons that the system can learn. An example of this can be seen in 2015, when the fee-for-service recovery audit contractor (RAC) program for Centers for Medicare & Medicaid Services (CMS) Medicare found $171.38 million in corrections for reimbursements from health systems, hospitals, and other providers, according to the American Hospital Association’s (AHA’s) RACTrac survey 4th Quarter 2015 results. This is why independent audits are essential for the healthcare industry in order to improve their Joyce CPA, LLC is a top healthcare auditor in the Cutler Bay area. Call us today for your auditing needs!


Benefits of Audits for the Healthcare System


Health plan audits can help to streamline and examine the industry in question, providing valuable insight and benefits for the industry as well as consumers. One way that health plan audits can help the industry is that audits can assist many organizations improve their clinical documentation, coding, and billing processes. Valuable insight for quality improvement initiatives can be provided by reimbursement tempests. A recent example of how this may be the case is evident in a large, Level 1 trauma center in Atlanta, Georgia. This trauma center utilized their Medicare administrative contractor (MAC) audit findings (formerly prove and educate audits) to guide them in clinical documentation improvement (CDI) and electronic health record (EHR) upgrades. Another healthcare organization was able to use their RAC audits as a series of guidelines to navigate new process improvements in rehabilitation services.


Operation Management Audits Can Improve the Healthcare Industry


Healthcare organizations can benefit greatly from an independent healthcare auditor like Joyce CPA, LLC, in order to clean up their systems and improve their experience. In the healthcare landscape, more and more prepayment and health plan audits are coming out of the woodwork. Hospitals can use them as useful tools and view them as new opportunities in order to implement cost savings in audit management, record request responsiveness, and health plan collaboration. There are several ways that they are able to capitalize on audit efforts. The first way is to be aware of these audits. As audits are becoming more common as well as more thorough in their scrutiny of health information from clinical documentation, medical records, and EHR, it is important for providers to be aware of these audits and keep them in mind when running operations. Secondly, these audits help streamline operations as they focus on searching for improper payments and thus directly impact healthcare facilities financially. Lastly, the only way to reduce costs with so many audits ahead is through hiring strong audit managers that work closely with quality, compliance, coding, and reimbursement teams. This kind of approach will allow lessons gleaned from each audit to be collected in order to improve compliance and mitigate future audit risk.


Contact Us Today


Operation management audits can assist in streamlining processes and finances for healthcare providers and institutions. Joyce CPA, LLC is a top healthcare auditor in the Cutler Bay area. Call us today for your auditing needs!

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