MDaudit’s 2023 Benchmark report found that external audit requests were up 4x from 2022. As the number and length of demand letters grow, healthcare organizations continue to face the ongoing challenge of managing these external audit requests effectively while maintaining operational efficiency. This is where innovative external audit workflow solutions come into play, revolutionizing the way audits are conducted and managed.
The Importance of External Audit Workflow Solutions
External audit workflow solutions are the backbone for healthcare organizations striving to navigate the intricate web of regulatory requirements and payor scrutiny. These solutions streamline the auditing process from initial assessment to resolution by removing manual data entry, automating tasks, facilitating collaboration, and providing actionable insights.
A well-rounded solution will help providers better manage external audits by:
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Driving Efficiency
Manual audit processes are not only time-consuming, but also prone to errors. External audit workflow solutions automate repetitive tasks such as data collection, analysis, and reporting, allowing healthcare professionals to focus their time and expertise where it matters most.
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Ensuring Compliance
With constantly evolving regulations and payor requirements, compliance is a top priority for healthcare providers. External audit workflow solutions integrate compliance checks into the auditing process, ensuring adherence to industry standards and regulations.
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Creating a Holistic Workflow Approach
Healthcare teams can benefit from a holistic workflow approach, especially those facing present-day challenges in staffing and talent shortages. Lean teams require synergy in communication to handle external audits accurately and productively. With automated reporting and auditing functions, the right solution will break down team silos while creating synergy across billing compliance, health information management (HIM), coding, and revenue integrity teams.
Key Features of an External Audit Workflow Solution
External audit workflow solutions encompass a wide range of features designed to streamline the auditing process and maximize efficiency. From customizable workflows to real-time reporting, these solutions offer a comprehensive suite of tools tailored to the unique needs of each healthcare organization.
A robust external audit workflow solution should include these key features:
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Customizable Workflows
Every healthcare organization has its own set of audit requirements and priorities. Audit workflow solutions offer customizable workflows to align with organizational policies, regulatory mandates, and industry best practices.
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Collaboration Tools
Effective communication and collaboration are essential for successful external audit management. External audit workflow solutions provide built-in collaboration tools that enable seamless communication and coordination among audit team members, coding professionals, and other stakeholders. From assigning tasks to sharing documentation and feedback, these tools facilitate real-time collaboration, ensuring transparency and accountability throughout the audit process.
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Real-time Reporting
Timely access to external audit findings and insights is critical for driving informed decision-making and action. External audit workflow solutions offer real-time reporting capabilities providing stakeholders instant visibility into audit progress, findings, trends, and financial outcomes.
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Integration Capabilities
Healthcare organizations rely on many systems and technologies to manage their operations. External audit workflow solutions offer cohesion with existing IT infrastructure, including electronic health record (EHR) systems, billing platforms, and coding software.
MDaudit’s External Audit Workflow (EAW) Solution
MDaudit’s External Audit Workflow solution makes it easy to manage external audit requests from third-party governmental and private payor audits such as Recovery Audit Contractors (RAC), Targeted Probe and Educate (TPE), Comprehensive Error Rate Testing (CERT) audits and more from a single centralized, secure platform.
Direct benefits of using MDaudit’s EAW solution include:
- Optimizing response times to external auditing requests for government and commercial payors
- Automating unwieldy, manual tasks to ensure deliverables are executed on time and in sync with challenging appeal deadlines
- Recognizing successful appeals and significantly reducing refunds through automation and a streamlined workflow, ensuring revenue protection
- Gaining full transparency via dashboarding and artificial intelligence into what is being targeted, why, and by who
- Using solution insights to develop a proactive and strategic approach to minimize compliance risks and revenue leakage
- Fully equipped with electronic submission of medical documentation (esMD), a centralized, HIPAA-compliant repository of all documentation needed, task management automation, sophisticated reporting and dashboarding, seamless workflows, and SmartScan.ai (artificial intelligence functionality)
- Proven success in managing and appealing diagnosis-related group (DRG) downgrades and other payor reimbursement challenges
EAW Success Story
National Spine and Pain Center (NSPC) is in 12 states, with more than 120 locations, and 750 medical professionals. They operate from both ambulatory surgery centers (ASCs) and physician clinics. For over 30 years, NSPC has been a pioneer in the relief of chronic and acute pain through minimally invasive procedures. NSPC offers three types of specialty treatment including pain medicine, neurosurgery, orthopedic treatment, and labs.
Before MDaudit, NSPC utilized a manual platform with no built-in processes for audit reporting or tools to support provider education. “We were experiencing the same problems as everyone else- letters are coming in, you do not know who is getting them, you might get the letter, you might not get the letter. There is no tracking or trending, so you do not have visibility into who is auditing you, or what they are auditing you for. There was no process to notify the physicians or educate them.”- Kelly Martinelli, Director of Compliance
With MDaudit’s External Audit Workflow (EAW) artificial intelligence (AI) function, SmartScan.ai, NSPC audit requests are scanned in, and the case numbers, dates of service, and even the internal control numbers (ICNs) are all accurately pulled in. Within 12 months of using MDaudit’s External Audit Workflow solution, NSPC increased its weekly external audits by 20% and retained 90% of at-risk revenue.
