Let’s talk about audits

HomeTown Health

Topics

• Background

• Trends

• Financial risks

• Discovery Audit Management Support services

• Next steps

Background• Healthcare providers face the challenge of complying

with an alphabet soup of audits RAC MAC MIC PERM ZPIC RAC DME Medicaid RAC HEDIS DOJ Plus

Commercial Payor audits

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Government Alphabet

Audit relationships

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Audit trends

• Increasing type and frequency• RAC activity increased almost 30% in Q1 vs. Q4 2011

i.e. Medicaid RAC, Medicare RAC DME part D

• Increase in number of providers audited• Increased expenses to manage audits

55% of reporting hospitals spent $10K or more in Q1 on RAC

Report average outside services spending of $75 + per audit

• Increased burden on staffing Reporting hospitals spend 4 hours or more on each audit 26% added staff to manage audit load

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Financial Risks

• Increased risks to healthcare providers financials

• Q1 RAC denials $741 million 2X increase vs. Q4 2011 One-third of audits uncovered inaccuracies

• 59% of reporting hospitals said no education on issues or errors from CMS or RAC contractor

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Audit Management Support

• Discovery offers specialized services to support your audit efforts

• Audit requests are not standard ROI requests Greater financial risk Special handling Expertise and experience

• Expediting & tracking• Electronic delivery and confirmation (see next slide)

esMD for eligible government audits Includes: RAC, MAC, PERM, CERT

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Audit Management Support

• Our program for audits includes Field review of request or claim letter

Identify due date Prioritization

Assembling relevant requested medical records Scan paper records Extract electronic records

Preparation and presentation of .pdf file for internal provider review and approval (if required)

Upload to Discovery for special handling Second review request or claim letter

Re-validate due date Processing, data entry, and QC

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Final review at Audit desk Trained Audit expert Establish / confirm distribution method

esMD or Print

Distribution via Trackable UPS delivery or esMD if eligible

On-line access through StatusNOW Detailed reporting Confirmation of receipt esMD

CMS Audit contractor

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Audit Management Support

• Cost effective Collect first from requestor where possible on commercial

payor audits

• Pricing model $0.12 per page $5.00 per claim esMD charge (where applicable) Shipping and handling at cost

• Getting started Create Statement of work Outline roles and responsibilities Amend agreement

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Questions

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RELAX !