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	<description>From workflow automation and risk analytics to revenue optimization, MDaudit&#039;s revenue cycle management software for healthcare is an all-in-one solution.</description>
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	<item>
		<title>What Manual Medical Auditing is Doing to your Organization</title>
		<link>https://www.mdaudit.com/blog/what-manual-medical-auditing-is-doing-to-your-organization/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=what-manual-medical-auditing-is-doing-to-your-organization</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Tue, 18 Oct 2022 10:12:58 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=25994</guid>

					<description><![CDATA[<p>Setting the Stage Manual medical claims auditing has long since and will remain, a highly specialized engine of cross-examination, driven...</p>
<p>The post <a href="https://www.mdaudit.com/blog/what-manual-medical-auditing-is-doing-to-your-organization/">What Manual Medical Auditing is Doing to your Organization</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<h4>Setting the Stage</h4>
<p>Manual medical claims auditing has long since and will remain, a highly specialized engine of cross-examination, driven by immensely talented auditors and revenue integrity specialists. They are the workforce that keeps hospitals financially viable, protecting their institution from insurance takebacks and securing revenue to prevent costly leakage. In a world that is rich with <a href="https://www.fiercehealthcare.com/finance/health-services-m-a-deals-surged-2021-here-are-some-trends-could-impact-deal-making-next">institutional mergers and acquisitions</a>, revenue integrity specialists and claims auditors are finding themselves responsible for a growing number of providers, claims, and billing compliance scenarios. With the Office of Inspector General (OIG) and commercial payers both aggressively auditing institutions (often armed with augmented and artificial intelligence), it’s time to reexamine the age-old institution of manual medical claims auditing.</p>
<p>What has worked in the past is no longer working for today’s healthcare organizations. What follows is an evaluation of the manual medical claims auditing system, its key inefficiencies, and its potential for change.</p>
<h4>A Word on Resources</h4>
<p>The true culprit of any overtaxed, inefficient status quo process is often a <strong>lack of resources</strong>. While it’s apparent that medical claims auditing is chronically plagued by a lack of time and staff (qualified auditing and revenue retention specialist staff are always in demand), conventions make inefficient use of both. Below are three key areas that are affected by the inefficiencies of manual medical auditing, and their negative externalities</p>
<h4>Insufficient Sampling</h4>
<p>As health groups increase in size and the number of external audits rises, it’s important to understand which services are being inappropriately coded, and where revenue leakage and takebacks are most prevalent. When conducting randomized medical claims audits manually, limited resources and time dictate a relatively <strong>small sample size </strong>compared to an institution&#8217;s total claims. While there may be thousands of claims and codes produced monthly in a single institution, randomized manual auditing results in a small fraction of those being critically examined (<a href="https://www.aapc.com/medical-auditing/medical-auditing.aspx">the OIG recommends a sample of 5 to 10 charts per provider for a multiple-provider audit</a>).</p>
<p>So while manual auditing does restrict the capacity of auditors, it does nothing to support data-driven<strong> </strong><a href="https://www.hayesmanagement.com/project/white-paper-from-reactive-to-proactive-implementing-a-risk-based-auditing-strategy-for-healthcare-organizations/"><strong>risk-based auditing</strong></a>. Using automated medical auditing software with analytics, auditors and revenue integrity specialists can harness data to attack larger swaths of internal data for those at the highest historical risk for denials.</p>
<h4>Poor Opportunities for Corrective Action Education</h4>
<p><a href="https://www.hayesmanagement.com/tips-for-educating-providers-and-coders-about-audit-findings/">Healthcare provider education</a> is an essential part of sealing revenue within an institution and preventing miscoding. A recent study showed that surveyed hospitals discovered their providers <a href="https://physicians.dukehealth.org/articles/steps-avoid-overcoding-and-undercoding#:~:text=Overcoding%20occurs%20when%20reporting%20Current,and%20can%20trigger%20an%20audit.">were only coding correctly 30% of the time</a>. Auditors and revenue integrity professionals are an essential line of defense for catching these mistakes, identifying the trends, and implementing corrective action. However, when these people have too much on their plate, they cannot spend time with providers performing <a href="https://www.hayesmanagement.com/a-proactive-approach-to-corrective-action-planning-cap/">corrective action education</a> to ensure mistakes are not repeated systemically.</p>
<p>By automating aspects of the medical claims auditing process, auditors and revenue integrity specialists will be empowered to more accurately and quickly identify coding and billing trends and preemptively prevent them through education.</p>
<h4>Overtaxed Staff</h4>
<p>Finally, manual medical auditing is a tremendous burden on the most valuable element of the medical claims auditing and revenue integrity process: staff. This process is already highly detailed, often tedious, and very high stakes. Conducting claims audits and evaluating for revenue integrity manually makes it as hard as possible for auditors and revenue integrity professionals. Combing through mountains of records detracts from time better spent analyzing and educating. Medical auditing software helps revenue integrity professionals avoid takebacks from both governmental and private insurers, retain revenue within the organization, and protects their time, empowering them to better address systemic inconsistencies and mistakes.</p>
<p>With over<a href="https://www.hayesmanagement.com/project/healthcare-auditing-and-revenue-integrity-2021-benchmarking-and-trends-report/"> $37 billion recovered</a> from individuals and companies by HHS and the OIG in the past decade, It’s important that these professionals focus on compliance and optimizing their institutions, not digging for data.</p>
<h4>What’s Broken and What’s Not?</h4>
<p>The fact is that auditors serve an invaluable role in protecting their institutions and supporting their financial viability. With proven <a href="https://www.hayesmanagement.com/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/">medical auditing software</a> available and even <a href="https://www.aapc.com/medical-auditing/medical-auditing.aspx">officially recommended by AAPC</a>, there is little reason for manual medical auditing to continue hindering their performance abilities. Medical auditing software cannot and will not replace the skill and subjectivity of trained medical claims auditors and revenue compliance experts — rather, it is an invaluable tool to improve their efficacy.</p>
<p>By recruiting the power of medical auditing software, medical claims auditors and revenue integrity specialists can continue performing their essential functions at a higher level, supporting and fortifying their institutions and providers.</p>
<p>Click<a href="https://www.hayesmanagement.com/software-mdaudit/"> here</a> to explore MDaudit’s suite of audit software services.</p><p>The post <a href="https://www.mdaudit.com/blog/what-manual-medical-auditing-is-doing-to-your-organization/">What Manual Medical Auditing is Doing to your Organization</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>Working with Workflows to Avoid Denials</title>
		<link>https://www.mdaudit.com/blog/working-with-workflows-to-avoid-denials/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=working-with-workflows-to-avoid-denials</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Fri, 14 Oct 2022 10:15:48 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<category><![CDATA[Revenue Integrity & Revenue Cycle]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=25997</guid>

					<description><![CDATA[<p>This is part three in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and...</p>
<p>The post <a href="https://www.mdaudit.com/blog/working-with-workflows-to-avoid-denials/">Working with Workflows to Avoid Denials</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><em>This is part three in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and managing workflows for maximum efficiency.</em></p>
<p>Denial rates continue to rise and payers are <a href="https://www.hayesmanagement.com/using-technology-to-keep-pace-with-payers/">increasing investments in advanced technologies</a> to further scrutinize claims in the future. In the first three quarters of 2022, a staggering 82% of initial claims were rejected by Medicare Part A and Part B payers. As the number of denials is growing, so too is the dollar amount &#8211; the average amount of hospital inpatient charges denied has increased by nearly 10% since last year, to more than $5800. More than ever, preserving health system revenue is as important as growing revenue.</p>
<p>Avoiding denials and increasing first-pass payments are the most effective way to protect revenue integrity. This requires the cleanest, most accurate claims possible, but with so many charges streaming through a health system on any given day, implementing effective and efficient revenue integrity workflows is crucial.</p>
<p><strong>As revenue teams face ongoing resource constraints, identifying and prioritizing the greatest denials risk can allow health systems to focus strategically on the most impactful source of claims denials.</strong></p>
<h3>MAXIMIZE IMPACT</h3>
<p>Knowing that as little as 20% of denials volume can drive as much as 80% of denials dollar amounts, smart health systems are finding ways to maximize limited staff resources by developing workflows that give special attention to those claims with the most significant impact on their bottom line.</p>
<p>Claim scrubbers are a good first step. But as we discussed in <a href="https://www.hayesmanagement.com/blog-why-claim-scrubbers-fail/">part one of this blog series</a>, claim scrubbers still miss a lot of reasons for high-dollar denials. Payer-driven rules engines are a tremendous game-changer in avoiding denials, but even they require some level of human review and corrections.</p>
<p>With teams stretched thinner than ever, there are three key approaches to optimally identifying and prioritizing denials risk:</p>
<ol>
<li>Leverage data analytics to diagnose denials trends</li>
<li>Prospectively audit claims to proactively mitigate denials</li>
<li>Employ risk-based audits and subsequent education to address systemic issues</li>
</ol>
<h3>IDENTIFY &amp; PRIORITIZE DENIALS TRENDS</h3>
<p>Advanced data analytics can offer meaningful insights using remittance data to diagnose systemic denials trends and monitor the effectiveness of mitigation programs. By identifying and reporting on the most important denial trends affecting compliance and revenue, focus can be given to high-risk areas to correct issues before they occur &#8211; preventing revenue loss and reducing the time spent in accounts receivable to accelerate cash flow.</p>
<h3>PROACTIVELY MITIGATE DENIALS</h3>
<p><a href="https://www.hayesmanagement.com/decrease-denials-by-introducing-prospective-audits/">Prospective auditing</a> offers auditors an opportunity to review charges before the bill is sent out to the payers and prevent problematic claims from being submitted and subsequently denied. Increasingly, teams are taking adding prospective audits to existing retrospective audit workflows to proactively mitigate compliance and revenue issues.</p>
<p><strong>Prospective audits account for 31% of all professional, hospital, and coding audits performed this year &#8211; up more than 20% from last year. </strong></p>
<h3>FOCUS ON SYSTEMIC RISKS</h3>
<p>Preventing billing errors before they occur is the most efficient means of mitigating denials. Risked-based audits address potential problem areas preemptively, stopping them from becoming more serious revenue and compliance issues. This workflow makes eases the burden of discovering and resolving issues, saving health systems time and money.</p>
<p>Due to the dynamic nature of emerging risks, revenue integrity teams must rely on real-time data and analytics at scale across their organizations to detect risks. When combined with proactive measures and ongoing monitoring, risk-based audits help to improve revenue flow by changing billing practices before errors are made.</p>
<p><strong>Risk-based audits have increased by 28% across professional and hospital billing as compared to 2021.</strong></p>
<h3>GET IT RIGHT</h3>
<p>Effective revenue integrity workflows require the <a href="https://www.hayesmanagement.com/project/audit-software-buyers-guide/">right technology</a>, subject matter expertise, and collaboration and communication between departments. Together, revenue integrity teams can identify, prioritize, and address systemic denial risks with the most significant financial impact, maximizing precious resources where they are needed most.MDaudit’s cloud-based <a href="https://www.hayesmanagement.com/revenue-integrity-suite/">Revenue Integrity Suite</a> automates an end-to-end denials prevention process that uniquely leverages payer remits to diagnose systemic risk based on trends, applies those insights to pre-bill charges to identify potential denials, and recommends erroneous claims for proactive audit and corrections before releasing to payers, resulting in lower denials.</p>
<p><a href="https://meetings.hayesmanagement.com/revenue-integrity-suite-demo">Schedule a demo</a> to learn how the Revenue Integrity Suite puts analytics into action to prevent 20% of high-value hospital charges that drive 80% of denials impact.</p><p>The post <a href="https://www.mdaudit.com/blog/working-with-workflows-to-avoid-denials/">Working with Workflows to Avoid Denials</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>5 Questions With a Customer: Stony Brook Medicine University Physicians</title>
		<link>https://www.mdaudit.com/blog/5-questions-with-a-customer-stony-brook-medicine-university-physicians/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=5-questions-with-a-customer-stony-brook-medicine-university-physicians</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Mon, 10 Oct 2022 10:19:08 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26000</guid>

					<description><![CDATA[<p>The MDaudit team was recently able to sit down with Laura McNamara, MBA, MS, CHCSB-CPMP &#38; SB-ACO, Compliance Officer at...</p>
<p>The post <a href="https://www.mdaudit.com/blog/5-questions-with-a-customer-stony-brook-medicine-university-physicians/">5 Questions With a Customer: Stony Brook Medicine University Physicians</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p>The MDaudit team was recently able to sit down with Laura McNamara, MBA, MS, CHCSB-CPMP &amp; SB-ACO, Compliance Officer at Stony Brook Medicine University Physicians, to discover how she and her team have benefited from implementing MDaudit into their organization.</p>
<ol>
<li><strong>How would you describe the value that MDaudit delivers?</strong></li>
</ol>
<p>The overall value of MDaudit lies in the ease of use and all the features it provides. Most importantly, however, the most significant value is the freedom from being paperbound. Migrating from paper dependence to a one-stop digital platform has done wonders for our work product. We can run reports, and historical data, look at specific risk areas, bell curves, and data mine, all in our efforts to mitigate organizational risk continually.</p>
<ol start="2">
<li><strong>How does the MDaudit team support you in your overall goals?</strong></li>
</ol>
<p>We meet with the MDaudit team at least quarterly and more often when requested. Our meetings are always valuable, as the team provided a dashboard and reports showing us how we use the system. They also offer recommendations for optimizing MDaudit, giving us examples of best practices and scenarios from other organizations. Their customer service is top-notch – always friendly and consistently delivering with a smile.</p>
<ol start="3">
<li><strong>Who across your organization benefits from MDaudit and how?</strong></li>
</ol>
<p>Everyone across the organization for whom our department supports benefits from MDaudit because they are our stakeholders. Primarily though, our team receives the biggest benefit because they can produce a high-quality work product. This includes our Compliance Analysts, who pull data and reports for the Auditors and Specialists. Who, in turn, audit documentation and MDaudit to execute their work. Our Manager performs data mining to identify risks related to Risk Adjustment Factor Scoring. And our Director of Compliance Operations oversees all the work performed by the team. She also works with the Compliance Officer to perform benchmarking and bell curve analysis used to report to organizational leadership.</p>
<ol start="4">
<li><strong>In what ways does MDaudit scale to meet the needs of an organization of your size in particular?</strong></li>
</ol>
<p>Since adopting MDaudit, we have expanded the scope of work by almost double. We have added risk-focused auditing based on data pulled from MDaudit. We have also launched a Risk Adjustment arm in our department with audits of Hierarchal Condition Categories (HCC) codes. This allows us to continue to identify high-risk areas based on the OIG Workplan, our risk assessment, etc., in a timely fashion.</p>
<ol start="5">
<li><strong>How have MDaudit integrated workflows and automated data ingestion impacted you </strong><strong>and your team? </strong></li>
</ol>
<p>MDaudit’s methodology was a changing point for our team. We have increased productivity from the creation of the audits to the execution of the audits themselves. One specific impact area is that we now rely on automated workflows for provider re-audits. Plus, our team has benefited from accessing the MDaudit learning modules, which have helped streamline their workflow processes.</p>
<p><strong>Anything you’d like to add?</strong></p>
<p>Overall, we have been quite happy with MDaudit. From the customer service to the product itself, we have been quite satisfied and are glad we did not hesitate to onboard this product.</p><p>The post <a href="https://www.mdaudit.com/blog/5-questions-with-a-customer-stony-brook-medicine-university-physicians/">5 Questions With a Customer: Stony Brook Medicine University Physicians</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>7 Steps to Take When Notified of a Third-Party Payer Audit</title>
		<link>https://www.mdaudit.com/blog/7-steps-to-take-when-notified-of-a-third-party-payer-audit/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=7-steps-to-take-when-notified-of-a-third-party-payer-audit</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Mon, 03 Oct 2022 10:22:38 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26006</guid>

					<description><![CDATA[<p>As a medical facility or provider, it’s virtually inevitable that you will receive a third-party payor healthcare audit demand letter....</p>
<p>The post <a href="https://www.mdaudit.com/blog/7-steps-to-take-when-notified-of-a-third-party-payer-audit/">7 Steps to Take When Notified of a Third-Party Payer Audit</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p>As a medical facility or provider, it’s <a href="https://bluemark.net/the-healthcare-insurance-audit-process/">virtually inevitable</a> that you will receive a third-party payor healthcare audit demand letter. What&#8217;s important is that you address the audit as efficiently and effectively as possible. Here are seven steps you should integrate into your healthcare audit management strategy.</p>
<h2><span style="font-weight: 400;">Steps to Take When You Are Audited</span></h2>
<p><strong>1. Immediately Address the Audit</strong><br />
<span style="font-weight: 400;">While the determination letter you receive may allow you up to 30 days to produce the documentation necessary, many facilities do not have a centralized repository of records. In this case, gathering the needed resources may take longer than anticipated. Acting swiftly will better facilitate deadline compliance.</span></p>
<p><strong>2. Assemble Documents</strong><br />
<span style="font-weight: 400;">Ensure that all applicable documentation is located and packaged appropriately.</span></p>
<p><strong>3. Conduct an Internal Audit of Records and Claims</strong><br />
<span style="font-weight: 400;">Once the proper documentation has been located and packaged, conduct an </span><strong>internal audit</strong><span style="font-weight: 400;"> of the records. You must ensure that you have all the proper documentation and that the records reflect the proper procedures that were followed. This is your opportunity to flag any mistakes or gather evidence that proper procedures were followed.</span></p>
<p><span style="font-weight: 400;">If improper care was administered, you have the opportunity to prepare for the financial repercussions of the takeback. If everything was conducted properly, this audit will prepare you for a potential appeals process should the auditor elect to invoke a takeback. </span></p>
<p><strong>4. <span style="font-weight: 400;">Securely Transfer Records</span></strong><br />
<span style="font-weight: 400;">The records auditors will request are related to the medical treatment of patients, and therefore fall under </span><a href="https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html"><span style="font-weight: 400;">HIPAA regulations</span></a><span style="font-weight: 400;">, and must be transferred confidentially and securely. It is the healthcare provider’s responsibility to ensure that all regulations are adhered to during this step of the process.</span></p>
<p><strong>5. Prepare for a Determination Letter</strong><br />
<span style="font-weight: 400;">If you conduct a thorough internal audit, you should possess a relative understanding of whether you will receive a determination letter. You may use this time to prepare an appeal case if appropriate. There may be cases where your healthcare audit concludes that your facility was guilty of providing unnecessary care, in which case preparing for an appeal is not necessary or wise. Instead, use this time to prepare for the takeback process. </span></p>
<p><strong>6. Appeal if Appropriate</strong><br />
<span style="font-weight: 400;">If your internal audit determined that all the care your facility staff administered was appropriate and you receive a determination letter requesting a takeback of funds paid, your facility may choose to file an appeal. In cases where you are faced with the opportunity to appeal multiple decisions, it is best practice to prioritize appeals of greater financial bearing. This is not a case of whether either appeal is more valid, it simply benefits you to designate resources towards appeals with greater potential benefits. </span></p>
<p><strong>7. Consider Corrective Action Processes</strong><br />
<span style="font-weight: 400;">If either your internal audit or the external audit reveals inconsistencies within your organization, enact a </span><a href="https://www.hayesmanagement.com/a-proactive-approach-to-corrective-action-planning-cap/"><span style="font-weight: 400;">Corrective Action Process</span></a><span style="font-weight: 400;"> or CAP. This step-by-step process can help you correct systemic flaws that can lead to more takebacks and affect your bottom line. </span></p>
<p><span style="font-weight: 400;">Healthcare insurance audits are a </span><a href="https://www.healthcarefinancenews.com/news/payer-payment-integrity-audits-are-financial-burden-providers"><span style="font-weight: 400;">costly, time-consuming, and overall taxing reality</span></a><span style="font-weight: 400;"> of being a healthcare provider. It is a best practice to take preemptive measures to protect your institution from being put in a vulnerable position. Here are some basic steps you can take to protect yourself:</span></p>
<h2><span style="font-weight: 400;">Steps You Can Take to Prepare for Future Audits</span></h2>
<p><strong>1. Conduct prospective audits</strong><br />
<span style="font-weight: 400;">After a taxing health insurance audit, the prospect of investing more resources in the auditing process can be unattractive. However, </span><a href="https://www.hayesmanagement.com/decrease-denials-by-introducing-prospective-audits/"><span style="font-weight: 400;">conducting prospective audits is an effective way to keep your institution ahead of the curve</span></a><span style="font-weight: 400;">. </span></p>
<p><strong>2. Institute a centralized repository database</strong><br />
<span style="font-weight: 400;">The effort it takes for institutions to locate, group, and verify patient records can be especially burdensome. Instituting a central repository database can alleviate resource strain by grouping data in an organized repository.</span></p>
<p><strong>3. Prepare to rank audits by appeal importance</strong><br />
<span style="font-weight: 400;">All healthcare audits are not created equal. While they may require similar amounts of work while preparing the records and sending them to the auditor, some appeals will have greater financial consequences than others. If your facility has multiple appeal opportunities, it’s important to prioritize cases whose outcome will have the biggest financial repercussions. In some cases, it may make sense to simply bear the cost of a smaller audit, to properly address a larger one. </span></p>
<p><span style="font-weight: 400;">The final step you can take to prepare for future healthcare insurance audits is to enlist the help of </span><a href="https://www.hayesmanagement.com/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/"><span style="font-weight: 400;">audit automation software</span></a><span style="font-weight: 400;">. Choosing the right software can empower you with the tools to:</span></p>
<ul>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Improve your auditing and billing compliance</span></li>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Ensure revenue and revenue cycle integrity</span></li>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Improve your Health Information Management (HIM)</span></li>
</ul>
<p><span style="font-weight: 400;">Click </span><a href="https://www.hayesmanagement.com/software-mdaudit/"><span style="font-weight: 400;">here</span></a><span style="font-weight: 400;"> to explore MDaudit’s suite of audit software services.</span></p><p>The post <a href="https://www.mdaudit.com/blog/7-steps-to-take-when-notified-of-a-third-party-payer-audit/">7 Steps to Take When Notified of a Third-Party Payer Audit</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>Using Technology to Keep Pace with Payers</title>
		<link>https://www.mdaudit.com/blog/using-technology-to-keep-pace-with-payers/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=using-technology-to-keep-pace-with-payers</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Fri, 30 Sep 2022 10:24:22 +0000</pubDate>
				<category><![CDATA[Blog]]></category>
		<category><![CDATA[Revenue Integrity & Revenue Cycle]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26009</guid>

					<description><![CDATA[<p>This is part two in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and...</p>
<p>The post <a href="https://www.mdaudit.com/blog/using-technology-to-keep-pace-with-payers/">Using Technology to Keep Pace with Payers</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><i><span data-contrast="none">This is part two in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and managing workflows for maximum efficiency.</span></i><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">With projected 2022 margins on pace to be the worst year for hospitals since the beginning of the COVID-19 pandemic, healthcare leaders must employ all available strategies to protect the financial health of their organizations. More comprehensive revenue integrity models are increasingly expanding traditional revenue cycle management processes in search of means to optimize reimbursement and eliminate revenue leakage.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">These organizational shifts are an essential step, but <a href="https://www.hayesmanagement.com/project/whitepaper-7-steps-to-strategically-planning-a-health-financial-outlook/">delivering a healthy bottom line</a> amidst record labor shortages, skyrocketing expenses, and supply disruptions will also require many healthcare executives to make larger strides to keep up with the latest advancements and emerging best practices. The industry is experiencing a surge of new technologies – including artificial intelligence (AI) and machine learning – designed to improve outcomes and maximize efficiencies.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<h4><span data-contrast="none">PAYERS ARE ALREADY THERE</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></h4>
<p><span data-contrast="none">Increasingly, payers are utilizing AI and machine learning to analyze claims and adjudicate before payments to reduce their administrative burden. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">Changes in payers’ claim review strategies and increased use of AI are contributing to slower payments and increased denials. Though payers were once likely to pay claims first and audit later, AI and machine learning enable them to now analyze large volumes of claims rapidly, resulting in more intense scrutiny prior to paying any claim that may be an anomaly.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><b><span data-contrast="none">In addition to a denial rate of 3 out of 10 claims (31%), an MDaudit analysis identified a 9.4% increase in lag days between initial claim submission and adjudication in the first quarter of 2022 as compared to the same period last year.</span></b><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">As payers become more sophisticated with advanced analytics and technologies, hospitals and health systems must respond in kind to optimize revenue. The complexity and ever-changing nature of payer requirements are more expansive than any team could possibly manage to predict and avoid denials. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<h4><span data-contrast="none">KEEPING PACE WITH PAYERS</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></h4>
<p><b><span data-contrast="none">To proactively identify and resolve claims likely to result in denials or delays before payer adjudication, leading healthcare organizations are <a href="https://www.hayesmanagement.com/blog-what-does-a-proactive-medical-coding-and-auditing-strategy-look-like/">moving beyond retrospective auditing</a> to more sophisticated daily risk monitoring and data analysis. </span></b><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">Implementing such revenue integrity-strengthening measures requires the necessary infrastructure. For example, MDaudit uses a unique, proprietary payer-centric rules engine. Leveraging rules based on a nationwide payer base, such tools apply advanced algorithms to help healthcare organizations reduce first-pass denial rates and accelerate payment by proactively detecting anomalies in at-risk claims prior to submission for adjudication. These rule sets provide an additional layer of validation not offered by traditional claims scrubbers, providing greater insights into the costliest sources of denials.  </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">Advanced analytics tools can also automate the previously manual process of mining thousands upon thousands of claims lines across denials to identify root causes and problematic revenue trends in healthcare for process improvement.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<h4><span data-contrast="none">REVENUE INTEGRITY RE-IMAGINED</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></h4>
<p><span data-contrast="none">When used in tandem, advanced diagnostic and predictive analytics such as denial data trends and the payer-centric rules engine can help revenue integrity professionals keep abreast of the challenge of payers’ ever-changing practices – to prevent denials before they occur, gain detailed insights into denial sources, and improve cashflow for the entire organization.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><span data-contrast="none">MDaudit’s cloud-based </span><a href="https://www.hayesmanagement.com/revenue-integrity-suite/"><span data-contrast="none">Revenue Integrity Suite</span></a><span data-contrast="none"> offers a reimagined, predictive way to mitigate denials.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p>
<p><a href="https://meetings.hayesmanagement.com/revenue-integrity-suite-demo"><span data-contrast="none">Schedule a demo</span></a><span data-contrast="none"> to learn how the Revenue Integrity Suite puts analytics into action to prevent 20% of high-value hospital charges that drive 80% of denials impact.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559685&quot;:0,&quot;335559731&quot;:0,&quot;335559737&quot;:-360,&quot;335559740&quot;:276}"> </span></p><p>The post <a href="https://www.mdaudit.com/blog/using-technology-to-keep-pace-with-payers/">Using Technology to Keep Pace with Payers</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>Why Claim Scrubbers Fail</title>
		<link>https://www.mdaudit.com/blog/why-claim-scrubbers-fail/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=why-claim-scrubbers-fail</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Tue, 27 Sep 2022 10:27:02 +0000</pubDate>
				<category><![CDATA[Blog]]></category>
		<category><![CDATA[Revenue Integrity & Revenue Cycle]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26012</guid>

					<description><![CDATA[<p>This is part one in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and...</p>
<p>The post <a href="https://www.mdaudit.com/blog/why-claim-scrubbers-fail/">Why Claim Scrubbers Fail</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><em>This is part one in a three-part series examining denials prevention, including the use of technology, payers’ ever-changing rules, and managing workflows for maximum efficiency.</em></p>
<p>As hospitals face unprecedented financial challenges, revenue retention will be as critical as revenue growth. More than half and possibly as many as two-thirds of all hospitals are expected to experience negative margins for 2022, based on a <a href="https://www.aha.org/guidesreports/2022-09-15-current-state-hospital-finances-fall-2022-update">recent report from the American Hospital Association</a> (AHA), with a possible decline of as much as 133% below pre-pandemic levels.</p>
<h3>AVOIDING COSTLY DENIALS</h3>
<p>In the ongoing fight to retain <a href="https://www.hayesmanagement.com/project/whitepaper-7-steps-to-strategically-planning-a-health-financial-outlook/">healthy margins</a>, eliminating preventable denials is a key battle strategy. With three out of ten claims (31%) initially denied in 2021, it is clear that more work can be done.</p>
<p>Submitting a clean claim without any errors or other issues that delay timely payment is key to <a href="https://www.hayesmanagement.com/project/leveraging-denial-trends-to-identify-compliance-and-revenue-risks/">effectively mitigating denials</a>. While some denials can be appealed, the manual processes necessary to work denial queues are time and labor-intensive and often require additional documentation review by the provider.</p>
<p><strong>Preventing 50% of avoidable denials would save ~$2B annually or $48M per hospital.</strong></p>
<p>Today, virtually all health systems use claim scrubbers to identify potential issues before claims are sent to the payer for adjudication. With the volume and complexity of medical coding and billing, these solutions are crucial for identifying and editing diagnosis and procedure code errors.</p>
<p><strong>But if claim scrubbers are so great, why are there still so many denials?</strong></p>
<h3>THE NEED FOR ADDITIONAL VALIDATION</h3>
<p>Claim scrubbing identifies coding accuracy errors but does not identify charges that will be denied for more complex issues, including medical necessity and those for which more information is needed. These denials represent high-dollar inpatient and outpatient claims.</p>
<p>MDaudit’s analysis of denial data of 13M claims denied in the MDaudit User Community for the denial categories: “Information Needed,” “Informational,” and “Medical Necessity” found that $16 billion​ was denied in 2021. The average claim amount was $1.2k.</p>
<p>Preventable denial categories not identified by claim scrubbers:</p>
<ul>
<li>Drug exceeds charge threshold</li>
<li>Treatment coverage issues</li>
<li>Notable off-label use</li>
<li>Orphan drug use</li>
<li>Drug – diagnosis combination issues</li>
<li>DME utilization and pricing</li>
<li>Bundled implant charges</li>
<li>Age – diagnosis issues</li>
</ul>
<p>Payer-side complexities add to the challenges of denial management that claim scrubbers cannot address. Denial rates vary significantly between payers and are constantly changing. Additionally, the vague denial reasons offered by payers often leave healthcare organizations struggling to pinpoint the root causes of the denials, which makes future denial prevention all the more elusive.</p>
<p>Resource-savvy health systems recognize that an additional layer of claims validation is crucial. A more sophisticated system is needed – one that leverages artificial intelligence and payer rules to more accurately predict and prevent denials.</p>
<p>In the fight to retain revenue, creating the cleanest claims is crucial, but not enough. In the next installment of this three-part series, we will explore how payers are investing in advanced technologies and approaches for claims review, and how health systems can leverage predictive analytics to mitigate denials.</p>
<p><a href="https://www.hayesmanagement.com/about-us/contact-us/">Contact us</a> to learn how the Revenue Integrity Suite puts analytics into action to prevent 20% of high-value hospital charges that drive 80% of denials impact.</p><p>The post <a href="https://www.mdaudit.com/blog/why-claim-scrubbers-fail/">Why Claim Scrubbers Fail</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>5 Under-Examined Aspects of the Healthcare Revenue Cycle</title>
		<link>https://www.mdaudit.com/blog/5-under-examined-aspects-of-the-healthcare-revenue-cycle/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=5-under-examined-aspects-of-the-healthcare-revenue-cycle</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Tue, 13 Sep 2022 10:28:41 +0000</pubDate>
				<category><![CDATA[Blog]]></category>
		<category><![CDATA[Revenue Integrity & Revenue Cycle]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26015</guid>

					<description><![CDATA[<p>Healthcare organizations are feeling the pain as their top and bottom lines continue to contract. However, despite redoubled efforts, leakage...</p>
<p>The post <a href="https://www.mdaudit.com/blog/5-under-examined-aspects-of-the-healthcare-revenue-cycle/">5 Under-Examined Aspects of the Healthcare Revenue Cycle</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p>Healthcare organizations are feeling the pain as their top and bottom lines continue to contract. However, despite redoubled efforts, leakage in healthcare revenue cycles continues to impact many organizations at a broad and deep level, exacerbating this financial pressure. To mitigate this, organizations must look across their cycle to identify potential areas of risk.</p>
<h2>Stopping Leakage in the Healthcare Revenue Cycle</h2>
<p>The healthcare revenue cycle offers ample opportunity for leakage from end to end. Inefficiencies in your organization&#8217;s RCM seriously threaten its operational health. In response to this inconvenient truth, healthcare providers are shifting away from manual processing systems to automated, electronic processes.</p>
<p>By examining each stage of the cycle, any sources of leakage that your facility may be experiencing become easier to identify. Though the lines between the three phases of RCM are indistinct, some steps belong squarely to one part of the cycle. However, certain processes serve multiple functions and are likely to occur at different points (eligibility verification, for example).</p>
<p>Let&#8217;s look at each of these stages to pinpoint the five aspects of the revenue cycle that are likely responsible for leakage in your organization.</p>
<h2>Front End</h2>
<p>The front end of the process consists of the tasks performed <a href="https://www.naham.org/page/ConnectionsAllinThisTogether" target="_blank" rel="noopener">up until the moment of patient admission</a>. They include:</p>
<ul>
<li>Scheduling</li>
<li>Pre-registration</li>
<li>Authorization / Pre-certification</li>
<li>Medical Necessity</li>
<li>Registration</li>
</ul>
<p>These initial steps are crucial in your RCM process, as whatever happens on the front end will impact how the back end performs. Receiving complete and accurate information from patients during registration will help ensure a smooth billing and collection process. Conversely, incomplete or inaccurate data is likely to result in denials from insurers, leading to an arduous denial management process on the back end.</p>
<p>The goal of customer satisfaction should be top-of-mind during this phase of the cycle. Patients increasingly see themselves as patrons of the facilities and providers they visit, expecting friendly and engaging service. This makes the front end an even more important part of your revenue cycle, given the correlation between a customer&#8217;s satisfaction and the likelihood of retaining them. Optimizing your front-end processes will therefore help ensure a positive patient experience and support your organization&#8217;s revenue integrity.</p>
<p>Although room for improvement certainly exists in each of the three overlapping phases of your organization&#8217;s revenue cycle, many aspects of the front end can be especially problematic. Many claims denials stem from oversights and errors before a patient visits their provider. The most under-examined parts of the cycle&#8217;s front end are pre-registration, authorization (aka pre-certification or prior approval), and eligibility verification.</p>
<h3>1. Pre-Registration</h3>
<p>Keeping patient collections and payer reimbursements high must begin at the front end of the revenue cycle. Pre-registration is, therefore, <a href="https://www.experian.com/assets/healthcare/white-papers/white-paper-pre-reg-working-the-healthcare-revenue-cycle.pdf" target="_blank" rel="noopener">the most critical step of RCM</a>. It bridges the gap between scheduling and admission, demanding the utmost accuracy and efficiency for your organization&#8217;s revenue integrity. Using this moment to financially clear patients will protect your payer reimbursements, encourage the collection of patient payments, and improve overall patient satisfaction.</p>
<h3>2. Authorization</h3>
<p>Since payers must confirm whether particular medications or procedures will be approved for patients, providers should contact insurance providers for approval before performing any necessary procedures (preauthorization). Though retroactive authorization may be granted for emergency admissions, some payers deny claims if patients accept medical care without obtaining authorization before treatment. As a result, errors in this step often lead to denials, making it worth your organization&#8217;s attention.</p>
<h3>3. Eligibility Verification</h3>
<p>A patient&#8217;s insurance eligibility verification is one aspect that could happen at different stages. This time-consuming process requires advanced knowledge of clinical codes to ensure they&#8217;re applied correctly in your claims. Intense workloads and tight deadlines can make the tedious task of verifying insurance coverage a challenge for providers. Consequently, the revenue integrity of your organization calls for a staff that&#8217;s been trained in all aspects of eligibility verification to efficiently accomplish this task.</p>
<h2>Mid-Cycle</h2>
<p>The phase in the process that includes patient access and the activities of your patient accounting/business office, or the mid-revenue cycle, encompasses:</p>
<ul>
<li>Clinical documentation</li>
<li>Case management</li>
<li>Charge processing</li>
<li>Clinical coding</li>
</ul>
<p>Much attention has been given to the front and back ends of the cycle, whether receiving payments upfront or minimizing unpaid accounts receivable in the back office. The importance of an organization&#8217;s mid-revenue cycle is only recently being understood and appreciated. Initiatives like Clinical Documentation Improvement (CDI) and training in Computer Assisted Coding (CAC) have become more common as the need to maximize reimbursements has grown.</p>
<p>Technology plays a key role at this stage. Purpose-built software solutions can streamline the coding and documentation process to help you detect anomalies and identify billing trends. Moreover, with the publication of <a href="https://www.who.int/news/item/11-02-2022-icd-11-2022-release" target="_blank" rel="noopener">ICD-11</a>, new reimbursement models are driving healthcare providers to focus more audit activities on clinical coding. Given the high demand for accuracy and precision within the coding process, paying attention to this stage is crucial for stopping leakage and promoting revenue integrity throughout your organization.</p>
<h3>4. Clinical Coding</h3>
<p>Coding a patient&#8217;s visit properly and complying with payer requirements is a core element of your organization&#8217;s revenue integrity. Despite this, many healthcare providers neglect to consider coding as part of the process. Coders often report to a compliance director instead of a revenue manager, which only serves to keep the coding and billing teams siloed. Lack of effective collaboration among these departments is a prime source of revenue leakage. Consider a CAC training program to help optimize your mid-cycle.</p>
<h2>Back End</h2>
<p>This part of the process comprises all patient accounting services. The steps that take place between patient discharge and final account resolution include:</p>
<ul>
<li>Billing</li>
<li>Collections</li>
<li>Insurance follow-up</li>
<li>Cash posting</li>
<li>Denials management</li>
</ul>
<p>Billing and collections generally pay ample attention to the ongoing effort to plug leaks and reinforce revenue integrity. However, with payer denial rates experiencing all-time highs since the onset of COVID-19, denial management has assumed a more central role in RCM, calling for closer examination. This overlooked part of the revenue cycle is critical for determining root causes of denials to prevent them from happening.</p>
<h3>5. Denials Management</h3>
<p>With denials accounting for 15–20 percent of the total value of claims and consuming an average of almost three percent of organizations&#8217; annual net revenue, the importance of having a strong, data-driven denials management program for your organization has never been greater. Yet again, technology can mean the difference between success and failure in this area. Automated audit workflows and analytics programs can help you go beyond fixing transactional errors ad hoc so you can implement long-term corrective actions.</p>
<p>An emphasis on the quantity rather than the quality of appeals is partially responsible for the heavy revenue leakage inherent in this aspect of the cycle. Instead of appealing as many denials as possible, your organization should focus on denials prevention by getting to the bottom of each denied claim. <a href="https://www.hayesmanagement.com/project/leveraging-denial-trends-to-identify-compliance-and-revenue-risks/" rel="noopener">Understanding the root causes of denials</a> is your key to increasing first-pass pay rates and decreasing days in accounts receivable. That understanding will help you boost revenue integrity.</p>
<h2>A Case for Revenue Integrity</h2>
<p>Maximizing your organization&#8217;s revenue stream requires more than ensuring each process in the cycle is executed as efficiently as possible. A fundamental flaw in many RCM programs is their failure to <a href="https://www.hayesmanagement.com/project/white-paper-tying-the-knot-between-compliance-and-revenue-cycle-to-ensure-revenue-integrity/" rel="noopener">align the various departments performing the functions of RCM</a>. As a result of this siloed method, teams often operate reactively to revenue leakage and fix errors on a transactional basis rather than proactively creating long-term solutions.</p>
<p>Revenue integrity programs take traditional RCM steps further by <a href="https://www.hayesmanagement.com/coupling-compliance-and-revenue-cycle-to-ensure-revenue-integrity/">using a holistic model to optimize the cycle</a>. Successful revenue integrity programs achieve three primary goals:</p>
<ul>
<li>Departmental alignment that promotes operational efficiency</li>
<li>Increase in reimbursement collection through better audit processes and improved denials management</li>
<li>Billing compliance ensured by the elimination of overcoding and undercoding</li>
</ul>
<p>The results of implementing revenue integrity speak for themselves. Organizations that have established such programs saw their net collection increase by 68 percent, realizing 61 percent overall gross revenue capture and a 61 percent decrease in compliance risk.</p>
<p>Most revenue leakage is avoidable. Your organization can identify and correct the inefficiencies in your organization&#8217;s RCM by examining each stage of the lengthy cycle — front end, mid-cycle, and back end — and addressing under-examined aspects such as pre-registration, clinical coding, and denials management. Revenue integrity programs take a holistic approach to RCM to connect your organization&#8217;s disparate departments to optimize your revenue cycle.</p>
<p><a href="https://www.hayesmanagement.com/about-us/contact-us/">Contact us</a> to learn more about how MDaudit can help you optimize your revenue cycle.</p><p>The post <a href="https://www.mdaudit.com/blog/5-under-examined-aspects-of-the-healthcare-revenue-cycle/">5 Under-Examined Aspects of the Healthcare Revenue Cycle</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>Revenue Integrity Trends, Challenges, and Solutions</title>
		<link>https://www.mdaudit.com/blog/revenue-integrity-trends-challenges-and-solutions/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=revenue-integrity-trends-challenges-and-solutions</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Fri, 29 Jul 2022 10:32:05 +0000</pubDate>
				<category><![CDATA[Blog]]></category>
		<category><![CDATA[Revenue Integrity & Revenue Cycle]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26021</guid>

					<description><![CDATA[<p>MDaudit Examines the Latest Trends, Issues, and Solutions to Revenue Integrity Strategy For payers and health systems, revenue integrity strategy...</p>
<p>The post <a href="https://www.mdaudit.com/blog/revenue-integrity-trends-challenges-and-solutions/">Revenue Integrity Trends, Challenges, and Solutions</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<h2>MDaudit Examines the Latest Trends, Issues, and Solutions to Revenue Integrity Strategy</h2>
<p><span data-contrast="auto">For payers and health systems, revenue integrity strategy drivers for 2022 and beyond come down to higher patient volume and heightened regulatory scrutiny. That’s based on a review of data encompassing more than $100 billion in denied claims from a large cohort of users within the MDaudit ecosystem – an ecosystem that provides unique insights into evolving trends that can help shape revenue integrity strategies to streamline claims processing and reduce denials. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<h3><b><span data-contrast="auto">A Closer Look at Revenue Integrity Trends and Challenges</span></b><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></h3>
<p><span data-contrast="auto">The first trend affecting revenue integrity is probably the most obvious; this year, there is higher patient volume than we saw in 2021. This means that alongside staffing shortages and a tightened auditing and financial review landscape, health systems face negative revenue impacts requiring careful allocation of resources, tools, and technologies to contain and manage costs associated with services provided. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">Second, on the regulatory front, numerous critical updates are coming from CMS and OIG. One particularly notable call-out is the HHS budget – about $2 billion allocated for Medicare and Medicaid program integrity. This means we can expect an </span><a href="https://www.hayesmanagement.com/project/webinar-be-prepared-for-an-onslaught-of-external-audit-requests/"><span data-contrast="none">uptick in external audits</span></a><span data-contrast="auto"> of claims paid, with COVID-related services receiving the most scrutiny. Managing these and ensuring revenue integrity remains of vital importance.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">Finally, commercial payers are increasingly using technology (AI/ML) to rapidly analyze large volumes of claims before adjudicating them, resulting in more rejections. This is something that the providers need to start proactively managing to ensure once the claim goes out the door, it doesn’t get kicked back.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">Needless to say, AI/ML will play a significant role in both the provider and payer spaces. When we looked at our ecosystem of denials in 2021, we saw around 3 out of 10 claims denied, a trend we expect to escalate throughout the year.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">For example, when looking at </span><a href="https://www.hayesmanagement.com/blog-q1-mdaudit-revenue-integrity-insights/"><span data-contrast="none">denial data</span></a><span data-contrast="auto"> in the last 12 months and the percentage change in average denial per claim, the average dollar per claim in the practice setting increased by 3%. On the hospital outpatient side, it increased by 4%. Claims volumes are higher, but so are what is being denied and the value of each rejection.  </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">When we looked at what was happening on the practice side, we saw many claims submissions, billing errors, and missing documentation which resulted in denials. Many claims were also denied for telehealth services for similar reasons. On the hospital side, most denials were related to bundling and COVID-19-related services. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<h3><b><span data-contrast="auto">Common Ground for Revenue Integrity Strategies</span></b><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:259}"> </span></h3>
<p><span data-contrast="auto">When it comes to revenue integrity strategies, it is not a one-size-fits-all proposition. But there is a common thread, which can be summed up as </span><a href="https://www.hayesmanagement.com/project/white-paper-tying-the-knot-between-compliance-and-revenue-cycle-to-ensure-revenue-integrity/"><span data-contrast="none">cross-department collaboration</span></a><span data-contrast="auto"> and shared strategic goals. When queried about what their organization wanted to achieve in terms of revenue integrity and what they would consider success, two things emerged: The need to ensure that revenue opportunities are maximized and to achieve operational efficiency.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:259}"> </span></p>
<p><span data-contrast="auto">The latter is where analytics and technology play a significant role. Unfortunately, in most organizations, information gets lost, or there are disconnects between departments and processes. This hampers revenue integrity programs, which must be cross-functional and involve multiple departments, including billing, compliance, revenue cycle, coding, clinical, and IT. These programs require a platform to make these cross-functional processes happen by allowing everyone to see the same data and easily share insights. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">Here’s an example of this idea in practice: A health system with more than 40 facilities conducted risk-based audits during COVID-19 and discovered that a set of providers were improperly billing a particular service. When this was brought to the group’s attention, the providers indicated that the issue was a technology – not personnel – problem. So, the disconnect between the two parts found its solutions because of a comprehensive data review and the coming together of leaders across several areas. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<h3><b><span data-contrast="auto">A Four-Step Process for Revenue Optimization</span></b><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></h3>
<p><span data-contrast="auto">Using analytic tools to catch issues proactively, like the health system in the example above, helps identify where risks reside and to channel these insights into targeted prospective processes. It is a four-step analytics process encompassing: </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<ol>
<li><span data-contrast="auto">Risk analysis, a diagnostic process to understand the root causes of the risks. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}"> </span></li>
<li><span data-contrast="auto">Risk mitigation via audits, either scheduled or as part of risk remediation efforts, to determine necessary actions based on risk profiles and targets. </span><span data-ccp-props="{&quot;134233279&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></li>
<li><span data-contrast="auto">Educating providers, third-party vendors, coders, and even third-party auditors on revenue integrity processes.</span><span data-ccp-props="{&quot;134233279&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></li>
<li><span data-contrast="auto">Ongoing risk monitoring. </span><span data-ccp-props="{&quot;134233279&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></li>
</ol>
<p><span data-contrast="auto">The large volumes of data needed for monitoring and analytics can be automatically generated through AI and machine learning. At MDaudit, we ensure that those data are continuously ingested into our platform to identify risks across facilities and systems. </span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">These are just some advantages of utilizing a modern cloud-based revenue integrity platform like MDaudit. Once revenue optimization has been determined, denial risk can be evaluated. This leads to seamlessly running pre-built charges through a predictive engine, which can tag potential denials for remediation &#8212; retrospectively and prospectively.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p>
<p><span data-contrast="auto">To kick off the process and get your departments on the same page, </span><a href="https://www.hayesmanagement.com/demo-request/"><span data-contrast="none">schedule a demo</span></a><span data-contrast="auto"> with us to learn how.</span><span data-ccp-props="{&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}"> </span></p><p>The post <a href="https://www.mdaudit.com/blog/revenue-integrity-trends-challenges-and-solutions/">Revenue Integrity Trends, Challenges, and Solutions</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>What Does a Proactive Medical Coding and Auditing Strategy Look Like?</title>
		<link>https://www.mdaudit.com/blog/what-does-a-proactive-medical-coding-and-auditing-strategy-look-like/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=what-does-a-proactive-medical-coding-and-auditing-strategy-look-like</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Thu, 28 Jul 2022 10:33:46 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<category><![CDATA[Health Information Management (HIM) / Coding]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26024</guid>

					<description><![CDATA[<p>What would a billing compliance auditor’s job look like if they weren&#8217;t constantly overwhelmed by manual tasks and mountains of unwieldy...</p>
<p>The post <a href="https://www.mdaudit.com/blog/what-does-a-proactive-medical-coding-and-auditing-strategy-look-like/">What Does a Proactive Medical Coding and Auditing Strategy Look Like?</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p><span style="font-weight: 400;">What would a billing compliance auditor’s job look like if they weren&#8217;t constantly overwhelmed by </span>manual tasks and mountains of unwieldy claims data<span style="font-weight: 400;">? It would probably be less reactive and more proactive, focused on educating providers and protecting against future external audits. To minimize billing risks and maximize claim reimbursements,  adopting an aggressive strategy for coding and auditing is a critical way to have your teams working smarter, not harder.</span></p>
<p><span style="font-weight: 400;">Adopting such a strategy has never been more critical as it is today. <a href="https://www.hayesmanagement.com/project/white-paper-from-reactive-to-proactive-implementing-a-risk-based-auditing-strategy-for-healthcare-organizations/">Healthcare billing compliance requirements are becoming more extensive</a>, resulting in greater scrutiny over providers and facilities. This increase in oversight is prompting organizations to thoroughly examine their billing compliance, auditing, and revenue integrity in an effort to limit compliance risks. By taking a proactive rather than a reactive approach organizations can preempt any expensive coding errors and billing compliance risks.</span></p>
<h2><span style="font-weight: 400;">Heightened Third-Party Scrutiny </span></h2>
<p><span style="font-weight: 400;">Auditing agencies have expanded their oversight, leading to more penalties and takebacks that can be financially crippling for any organization. </span><span style="font-weight: 400;">The Office of Inspector General (OIG) investigates fraud and abuse, Recovery Audit Contractors (RACs) monitor hospitals for billing errors, Medicaid Integrity Contractors (MICs) look for Medicaid overpayments, and Zone Program Integrity Contractors (ZPICs) track Medicare fraud and abuse. The increased attention from these entities has compelled organizations to modify their strategies to ensure billing compliance and revenue integrity.</span></p>
<p><span style="font-weight: 400;">A proactive medical coding and auditing strategy has these core aspects:</span></p>
<ul>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">A risk-based auditing approach using technology to identify anomalous billing trends</span></li>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Employing regular </span><a href="https://www.hayesmanagement.com/five-ways-to-use-prospective-audits-to-boost-your-bottom-line/">prospective audits</a><span style="font-weight: 400;"> to significantly decrease the recurrence of aberrative billing patterns — and an</span></li>
<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Emphasis on ongoing monitoring and education</span></li>
</ul>
<p><span style="font-weight: 400;">A strategy that encompasses these can help auditors correct billing and coding errors prior to claim submissions, directly equating to significant decreases in denials and the maximization of reimbursements</span><span style="font-weight: 400;">. Each one can support your compliance efforts and contribute to the revenue integrity of your organization.</span></p>
<h2><span style="font-weight: 400;">The Risk-Based Approach</span></h2>
<p><a href="https://www.hayesmanagement.com/risk-based-auditing-why-it-may-be-the-right-choice-for-your-organization/">Risk-based audits</a> <span style="font-weight: 400;">are unscheduled and performed on a case-by-case basis. </span>However, performing full chart review audits on every potential risk is not feasible. It would help if you had volumes of billing data to examine provider billing patterns that appear anomalous. To do that effectively, <a href="https://www.hayesmanagement.com/project/audit-software-buyers-guide/">you must have the right technology</a>. An integrated software solution allows for continuous monitoring and analysis of your billing and claims data. Without the use of an automated solution, your teams are unable to address issues as they arise.</p>
<p><span style="font-weight: 400;">Being ready for <a href="https://www.hayesmanagement.com/external-audit-management/">audits by third-party entities</a> that may be scrutinizing your organization is essential for maintaining compliance and efficiency. Risked-based audits address potential problem areas preemptively, stopping them from snowballing into serious revenue and compliance issues. This approach makes discovering and resolving issues less of a chore, saving your organization time and money. When combined with ongoing monitoring, a risk-based approach becomes even more effective by directing audits toward known anomalies and risks.</span></p>
<p><span style="font-weight: 400;">By taking this approach, compliance awareness becomes imperative throughout your organization, with education playing a central role in ensuring compliance. Risk-based auditing also provides for more frequent reporting than annual risk assessment programs, facilitating a proactive approach to your medical coding and auditing.</span></p>
<h2><span style="font-weight: 400;">Prospective Auditing</span></h2>
<p><span style="font-weight: 400;">With the insights gained using a risk-based approach, you can prospectively audit cases that carry a greater risk of denial. The OIG guidelines can help you identify these cases, as can <a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program">RAC</a> and Medicare Administrative Contractor (<a href="https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/What-is-a-MAC">MAC</a>) work plans. You may also detect high-risk areas during external audits that could be targeted for prospective auditing. Proactive medical coding and auditing strategies employ prospective auditing to correct any billing and coding errors on your claims before payers can deny them.</span></p>
<p><span style="font-weight: 400;">Although retrospective auditing offers the benefit of an expanded time frame allowing for more claims to be audited, <a href="https://www.hayesmanagement.com/prospective-vs-retrospective-audits-our-view-you-need-both/">prospective auditing can help reduce your denial rate</a> since it catches errors in advance of claim submission. Both prospective and retrospective auditing become tremendously easier with the help of an integrated software solution. Audit software lets you automate auditing functions so your team can concentrate on data analysis and coding quality, saving your organization time and resources.</span></p>
<h2><span style="font-weight: 400;">Ongoing Monitoring and Education</span></h2>
<p><span style="font-weight: 400;">To ensure your organization’s compliance throughout its revenue cycle and promote revenue integrity, </span><a href="https://nahri.org/articles/keeping-tabs-compliance-internal-audits-and-monitoring"><span style="font-weight: 400;">continuous monitoring and internal auditing</span></a><span style="font-weight: 400;"> are essential. This is another aspect of the proactive coding and auditing approach that may be enhanced with audit software. With the time that can be saved by introducing automation to your audit processes, auditors can</span><span style="font-weight: 400;"> not only conduct more audits but also provide educational resources to coders and providers that help them improve the quality of their coding. </span></p>
<p><span style="font-weight: 400;">Coding errors and claim denials decrease when auditors can sit down with providers and coders to educate them on coding quality and its importance to revenue integrity. Providers (and coders) who receive the educational resources they need to maintain a high coding quality place considerable value on those resources, which ultimately leads to fewer errors and a greater opportunity to focus on the patient experience. Ongoing monitoring and continuing education are key components of proactive medical coding and auditing.</span></p>
<h2><span style="font-weight: 400;">Implementing Your Medical Coding and Auditing Strategy</span></h2>
<p><span style="font-weight: 400;">Finding the best strategy for your organization involves the consideration of several factors, time and cost being chief among them. A lack of human resources and confining dependence on outdated processes have held many providers back from implementing risk-based auditing and other techniques that characterize the proactive approach.</span></p>
<p><span style="font-weight: 400;">However, new processes and technologies have given these organizations hope. </span><a href="https://www.hayesmanagement.com/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/">There&#8217;s an extensive range of software platforms that have been developed</a><span style="font-weight: 400;"> to help them improve auditing efficiency and reliability. By employing new methods and tools, your auditors and compliance teams can deploy their resources effectively to minimize risk and maximize reimbursement. To do this, you’ll want to keep a few points in mind.</span></p>
<h3>Shedding Manual Processes</h3>
<p><span style="font-weight: 400;">Most auditing processes have not undergone the dramatic changes that digital transformation has brought to other areas of healthcare. Despite many recent technological advancements, organizations still rely on paperwork to run their operations. However, with medical audit software, you can significantly reduce the amount of paperwork that your company has to manage.</span></p>
<p><span style="font-weight: 400;">One of the key advantages offered by audit software is workflow automation. By automating the audit process, continuous risk monitoring and anomaly detection are built into your medical coding and auditing strategy. This enables you to detect risks, identify the root causes of claim denials and take corrective action to avoid them. You can invest the time your organization saves through automation in ongoing monitoring, education, and improving data quality.</span></p>
<h3>Sifting Through the Data</h3>
<p><span style="font-weight: 400;">Auditors spend much of their time simply gathering the data they need so they can review it. This leaves only a small portion of their schedules free for them to do what they should be doing: auditing. However, in a perfect world, that critical data would be processed by the time the auditors even begin their work. This would create the perfect opportunity for coding quality reviews, a primary feature of proactive medical coding and auditing strategies.</span></p>
<p><span style="font-weight: 400;">In addition to providing workflow automation, audit software gives auditors the indispensable advantage of analytics. Software platforms that compare billing data with <a href="https://pepper.cbrpepper.org/">PEPPER</a> reports can help identify anomalies and narrow down areas of focus based on what&#8217;s above or below normative ranges. Billing compliance departments typically lack the resources to analyze dense PEPPER reports and OIG work plans, making these platforms a critical tool for ensuring compliance.</span></p>
<p><span style="font-weight: 400;">The volumes of data that are available to healthcare providers are enough to overwhelm even the most experienced auditors. Cloud-based audit software, </span><a href="https://www.hayesmanagement.com/is-your-organization-ready-for-next-generation-revenue-integrity/"><span style="font-weight: 400;">powered by artificial intelligence</span></a><span style="font-weight: 400;"> and machine learning, can guide auditors to the most relevant data so they know where to concentrate their efforts. The right software platform helps them spot trends and identify any coders whose work deviates from normative ranges. Having anomaly detection as a feature of your audit software will ultimately allow for a greater patient experience.</span></p>
<h3>Focusing on the Patient</h3>
<p><span style="font-weight: 400;">Healthcare providers face increasing pressure to provide high-quality services quickly, not just for the sake of their bottom lines but for the convenience and well-being of their patients, who often need urgent care. <a href="https://www.hayesmanagement.com/coupling-compliance-and-revenue-cycle-to-ensure-revenue-integrity/">Billing compliance and revenue integrity are the guide rails</a> for your medical coding and auditing strategy, but the best possible patient experience is always your destination.</span></p>
<p><span style="font-weight: 400;">Healthcare organizations today must be proactive to stay compliant and strengthen revenue integrity. A proactive medical coding and auditing strategy typically entails taking a risk-based auditing approach, holding routine prospective audits, and investing in ongoing monitoring and education. Building these core elements into your organization’s strategy helps ensure that coders and auditors can correct billing and coding errors before they result in denials. By employing a proactive coding and auditing strategy, your teams can effectively reduce claim denials, minimize risk, and maximize reimbursement.</span></p>
<p><span style="font-weight: 400;">To learn how MDaudit can help you support your billing compliance efforts and bolster the revenue integrity of your organization, <a href="https://www.hayesmanagement.com/about-us/contact-us/">contact our team</a>.</span></p><p>The post <a href="https://www.mdaudit.com/blog/what-does-a-proactive-medical-coding-and-auditing-strategy-look-like/">What Does a Proactive Medical Coding and Auditing Strategy Look Like?</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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		<title>6 Dos and Don&#8217;ts of Choosing a Medical Billing and Auditing Software</title>
		<link>https://www.mdaudit.com/blog/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/?utm_source=rss&#038;utm_medium=rss&#038;utm_campaign=6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software</link>
		
		<dc:creator><![CDATA[MDaudit]]></dc:creator>
		<pubDate>Fri, 27 May 2022 10:36:42 +0000</pubDate>
				<category><![CDATA[Billing Compliance]]></category>
		<category><![CDATA[Blog]]></category>
		<guid isPermaLink="false">https://www.mdaudit.com/?p=26027</guid>

					<description><![CDATA[<p>When selecting a software package for your organization, it&#8217;s critical that you follow a proven methodology to evaluate your options...</p>
<p>The post <a href="https://www.mdaudit.com/blog/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/">6 Dos and Don’ts of Choosing a Medical Billing and Auditing Software</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></description>
										<content:encoded><![CDATA[<p>When selecting a software package for your organization, it&#8217;s critical that you follow a proven methodology to evaluate your options rather than relying on instinct or emotionally fueled preferences. Billing and auditing software has evolved; some platforms are exclusively for auditing, while others are designed for billing compliance, revenue cycle, and revenue integrity teams to audit charges while also providing insights into charge trends and anomaly detection, denial and remit analytics, audit insights, and more.</p>
<p>With your organization&#8217;s revenue at stake, choosing the right billing and auditing software is just as important as selecting an appropriate EMR solution. The right software selection will have broad and long-lasting implications across your organization, regardless of who uses the software directly. To guide you through this selection process, here are some key points to consider:</p>
<p><strong>DO</strong> Tell them what you want to see</p>
<p>When sharing your requirements, make them as &#8220;real-world&#8221; as possible. Align the examples to mirror situations that are likely to be encountered to allow the vendors to show how their software can resolve the problems.</p>
<p><strong>DON&#8217;T </strong>Just buy features</p>
<p>Remember to look at the &#8220;big picture&#8221; when making the final decision and consider the unintended consequences and impact of the final decision. A solution is more than a single feature, and many offer benefits your organization may not have even been aware of.</p>
<p><strong>DO</strong> Look for key differentiators</p>
<p>Evaluate the vendors on more than just the software. Look for things that the vendor can do for the organization or other benefits that can be accrued. Dedicated support teams and customizable implementation training can make all the difference.</p>
<p><strong>DON&#8217;T</strong> Be closed-minded</p>
<p>Consider every vendor fairly and without bias. Don&#8217;t allow your preconceived notions or the opinions of others to cloud your judgment when evaluating the software packages.</p>
<p><strong>DO</strong> Look for tangible benefits</p>
<p>The vendors will show features that have a &#8220;wow factor.&#8221; But try to evaluate the merits of those features to determine if they bring a value-added proposition to the organization.</p>
<p><strong>DON&#8217;T</strong> Fall for &#8220;Last Demo&#8221; syndrome</p>
<p>Evaluating software is a daunting task that takes time and effort. To get the most out of this critical step, keep your team focused on the questions that are relevant to your organization&#8217;s needs. Ask yourselves:</p>
<ul>
<li data-gc-list-depth="1" data-gc-list-style="bullet">What problems do we need this software to solve?</li>
<li data-gc-list-depth="1" data-gc-list-style="bullet">What can&#8217;t we do that we want to be able to do?</li>
<li data-gc-list-depth="1" data-gc-list-style="bullet">Is our organization prepared for such a big change?</li>
<li data-gc-list-depth="1" data-gc-list-style="bullet">Given our resources, can we afford a new software solution?</li>
</ul>
<p>The process of choosing the right medical audit software for your organization is an important one. From defining what the software will be used for, such as billing compliance and revenue integrity, to scheduling product demos and making your final decision to purchase, you&#8217;re going to want a trusted advisor by your side.</p>
<p>To help you through this process, check out our <a href="https://www.hayesmanagement.com/project/audit-software-buyers-guide/">Medical Audit Software Buyer&#8217;s Guide</a>. In it, you&#8217;ll learn the eight crucial steps you&#8217;ll want to take before you even start your software search. By following a proven approach to select the tech solution that&#8217;s the right one, your organization can minimize risk, increase efficiencies, and maximize revenue.</p>
<p><a href="https://www.hayesmanagement.com/project/medical-audit-software-buyers-guide/" target="_blank" rel="noopener noreferrer" data-gc-link="https://www.hayesmanagement.com/project/medical-audit-software-buyers-guide/">Click here to download the guide.</a></p><p>The post <a href="https://www.mdaudit.com/blog/6-dos-and-donts-of-choosing-a-medical-billing-and-auditing-software/">6 Dos and Don’ts of Choosing a Medical Billing and Auditing Software</a> first appeared on <a href="https://www.mdaudit.com">MDaudit</a>.</p>]]></content:encoded>
					
		
		
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