Audit and Compliance



A&C Mar

A new season of RAC audits kicked off in early March across the country. Your hospital will be impacted by this new phase of audits sooner or later, so now is the time to evaluate your audit management process for efficiency and effectiveness. Selecting the right solution to complement your organization's processes and systems is paramount to successful audit management and response.

Hospitals today need a solution that provides a strong foundation for its audit management process—a solution that enables an integrated, streamlined approach; seamless data sharing; and automated workflows. Manual work that requires significant staff time continues to plague existing processes and often times is the result of the audit software not "talking" to other systems.

Identifying a scalable solution is also critical. With organizational expansion becoming more commonplace, the ability to onboard new facilities to a consolidated audit management process is now a core requirement. Ensuring an easy and painless transition for the end-users is essential for success.

Beyond the technical requirements of a new solution, hospitals need the support of a technology solutions provider that understands the complexity of the audit landscape and can facilitate the continued evolution of required processes. This means finding an expert vendor that has the ability to look ahead, identify potential impacts on the workflows and proactively make appropriate system enhancements to continue to drive efficiency and results.

Technical Requirements to Consider

  • Integration of applicable systems. Every system or vendor used in managing the RAC process needs to be directly connected.
  • Real-time appeal tracking. A system that can generate real-time, automated worklists for staff and calculate due dates at all levels of appeal.
  • Electronic document repository. A single location which can consolidate all the various pieces of correspondence and documentation is critical.
  • Financial Reporting. Accurately report on denied dollars, including dollars at-risk versus dollars that have already been recouped from the facility, providing a clear view on the true impact of ongoing audits in real time.

Keys to Evaluating Solutions

  • Clearly identify all user requirements and validate against stated vendor deliverables.
  • Require strong client references and speak to those references.
  • Keep in mind the vendors or systems requiring interfaces.

The right audit solution ensures a smooth process for your organization and protects your reimbursement dollars.