Payers rely heavily on the use of data and data analytics to manage their risk. Follow these tips for using payer guidelines to understand what they’re looking for and how to improve documentation.
Without the guidance and expertise of compliance, revenue can’t be considered truly accurate and audit-proof. By using a compliance work plan to weave compliance best practices and audit findings into revenue integrity, organizations can flip revenue integrity processes from reactive to proactive.
Interdisciplinary team meetings are the perfect venue for revenue integrity to present changes that impact all providers or to discuss overall trends, but don’t allow for one-on-one discussions. To help craft personalized education tracks for providers, revenue integrity can use existing data from chart audits to build a road to success.
Q: When a physician schedules a procedure, do you evaluate the patient’s record prior to the procedure to determine whether all of the coverage requirements of the applicable National Coverage Determinations and/or Local Coverage Determinations are met?
Using revenue reports to create tailored metrics and then monitoring with revenue reconciliation will keep an organization on track to hit revenue goals and ensure that it’s able to plan for the correct amount of revenue.
Audits are a check-up for revenue integrity. Skipping a regular audit, like skipping an annual exam, can lead to larger, more costly problems down the line—and a lack of proper auditing and remediation in one department can easily spread problems to related departments.
