By Susanna Partrick, Senior Privacy and Compliance Administrator, Weill Cornell Medicine
Nearly eight out of ten healthcare internal auditors in a recent survey by PwC believe risks are increasing. As a result, almost nine out of ten say they have gone through or will soon be involved in significant business transformation. The conclusion is that these increased risks and transformative changes in the healthcare industry will require internal auditing to change as well.[1]
Unfortunately, few healthcare organizations are able to add resources during a time of shrinking revenue and tightening margins. To meet this increased demand, therefore, those of us responsible for the internal compliance program functions must find ways to be more efficient with the resources we do have. Doing more with less has become an inevitable mantra for compliance auditing groups in healthcare organizations striving to minimize overall risk.
The concepts of productivity and efficiency are often viewed negatively – as simply buzzwords to wring more output from overworked staff. That doesn’t have to be the case. A huge part of our responsibility as leaders is to work cooperatively with our teams to improve the amount of work being performed by optimizing their skills, our processes, and the technology under our control.
Here are five key steps you can take to improve the productivity and efficiency of your compliance audit team.
1. Set standards
Creating an environment of productivity requires working with the team to set appropriate expectations. Start by evaluating activity data and conducting actual time studies and incorporate the best practices of high performers to optimize your processes.
Audit feedback processes are particularly important and should include items such as:
- Email notification for passed audits
- Face to face or phone meetings for failed audits
- Presentation of both positive and negative findings
- Simplified, easy to understand summary reports
Once you’ve documented your processes make sure everyone is performing the same tasks in the same way. This is critical in achieving maximum efficiency.
Your process training should include proper use of the auditing software you may be using. Improper use of technology can be a major time waster. People may be well intentioned, but if they are not sure of what their system can do, they can often institute convoluted workarounds that greatly increases the time required to perform a specific task.
Once everyone is properly trained, the next step is setting standards for task performance. You have to put a stake in the ground or nobody is sure of what they should be doing. That leads to confusion that often drains productivity from your operation.
Some examples of standards include:
- Setting a certain amount of cases to be audited each day
- Committing to QA all audits by the end of the following work day
- Using common templates and established file structures
- Establishing timelines for routine audits, re-audits for providers with findings, and audit feedback loops
- Ensuring all activities are conducted and documented in your auditing software system every day
If you have both a central audit team and auditors assigned to specific departments, make sure everyone is auditing to the same overall compliance plan developed for the organization.
2. Develop your team
The key to improving efficiency and productivity is to have a dedicated team who buy into the program. For that reason, recruiting and developing outstanding people is one of the most important steps you can take.
Always look to build the organization by hiring great people and providing them with a clearly defined career path. One example is to hire administrative staff with college degrees with CPC or CPC-A certification. They then work with the team for 18 months to two years to learn the systems and processes. From there, they are eligible for promotion to compliance auditor when a position becomes available. We also provide cross training opportunities so they can expand their skill set.
Establishing a structured plan for individual improvement and the potential for growth and greater responsibility goes a long way to keeping the team motivated. It also makes them more likely to help you find ways to improve efficiency and productivity.
3. Encourage co-operation, accountability, and competition
One of the most effective ways to improve productivity is to develop an environment of co-operation, accountability, and friendly competition.
Holding each member of the team accountable – to management but more importantly to each other – is a crucial first step. Physicians are now being held to standards of productivity, performance, and quality. It is reasonable, therefore, that compliance audit staff should be held to established productivity and quality standards as well.
Productivity isn’t something that can be unilaterally imposed. It has to be the product of everyone involved co-operating and pulling in the same direction to meet established goals and drive efficiency into the compliance audit process. Establishing that kind of cooperative environment can result in achieving the high levels of productivity required to survive in the challenging health care environment.
You can also help improve productivity by setting specific goals for each task to encourage healthy competition. These benchmarks could include:
- Number of cases to be audited per day
- Number of audited cases to be QA’d per day
- Dollar amount of unbilled charges pending compliance review Dollar amount of charges on hold in compliance audit work queues
- Timeframe to resolve audit findings
To monitor activity and compare to productivity goals, have auditors submit a summary of daily activity – number of cases pending, number of cases audited, status of audited cases, cases on hold, and audit follow up activity. For managers, the report should track number of cases QA’d and other activity performed such as provider meetings or training sessions. Tracking and benchmarking activity in this way helps individual understand where they are excelling and where they may need to improve.
4. Optimize the use of technology
The number and scope of audit requirements in the healthcare industry makes manual auditing unfeasible. Your audit staff would need to be expanded exponentially to comb through mountains of claims and billing data to uncover risks or trends that could expose your organization to financial penalties.
To keep up with increased audit workload, your compliance organization needs tools that streamline and automate auditing and compliance efforts. An effective technology solution allows you to quickly analyze and measure your organizational risk, focus and monitor specific risk profiles, target your audits, and focus quality initiatives and education around findings.
Once you’ve implemented a compliance audit solution, you must commit to it fully. Use all the available features and leverage the standard system reports of your system. Eliminate any offline spreadsheet tools and processes that slow things down.
5. Get organized
Getting and staying organized are critical steps when striving to improve productivity and efficiency. Begin by clearly defining the tasks and designating the individuals to perform them. Here’s what a sample organization could look like:
Your Compliance Operations Manager is responsible for distributing audit assignments, developing audit reports, completing audits, monitoring unbilled charges pending audit, managing charges on hold in work queues, conducting/attending compliance review meetings, and coordinating the quarterly report process.
Compliance Specialists audit cases as assigned, send audit reports to providers, and resolve passed audits.
The Billing Compliance Managers QA’s audited cases and meets with providers to resolve failed audits. They review 20-30% of audited cases, conducts audit feedback meetings for all failed audits, monitor self-auditing departments, and conduct training as necessary.
To coordinate the activities of the team, it’s helpful to use a “central command” tool. This allows you to perform logistics/operations planning, review workloads, review pending audit cases, distribute daily and weekly assignments, and provide a big picture for the entire team.
It’s also helpful to maintain a single server for the entire audit team separating department folders by year, provider, audit reports, quarterly reports, and annual reports. Maintain an organized file structure with a data feed from your audit software. This set up eliminates multiple individual filing systems and provides quicker and more effective access to department files for all audit team members.
It’s important to remember that productivity isn’t a bad thing. Maximizing your resources to meet the your increasing demands makes it one of the most important – and necessary – things you can do to minimize the growing risks to your organization.
[1] Healthcare Internal Audit: In a Time of Transition, The 2015 State of the Internal Audit Profession Study, PwC, 2015.
