11 Strategies to Improve Your Healthcare Audit Process

Audits are essential to hospital operations and efficiency. They ensure adherence to regulatory requirements and safeguard patient safety. However, the audit process can be complex and demanding, often presenting significant challenges for healthcare institutions.

A robust audit strategy has several key components.  Leveraging technology and creating a workplace culture of consistent improvement  are crucial elements, as are meticulous documentation and practical staff training. The following tips outline a comprehensive approach to audit management.

1. Regularly Update and Maintain Accurate Records

Keeping detailed and precise patient records is essential. It is crucial to record every service, treatment, and procedure correctly. Inaccuracies or omissions in these records can be disastrous. Some results include misdiagnoses, revenue loss, incorrect treatments, and compromised patient safety.

Hospitals should document in a patient’s file. Communication and health information are most important. Document the audit process thoroughly and save it alongside organizational records. 

2. Leverage Electronic Health Records for Organized Recordkeeping

Digitally keeping records is the best way to support accurate and organized recordkeeping. Most hospitals use electronic health records (EHRs) to store patient data securely. An EHR, or electronic medical record, is a digital version of a patient chart. It contains comprehensive patient health information. You can share electronic health records across different healthcare settings, enabling a holistic view of patient care.

Electronic health records compliance with regulatory requirements requires accurate and thorough documentation. This is crucial for audits, as these records provide comprehensive evidence of regulatory compliance. For best results, ensure your medical records management system is current. It should meet audit requirements from implementation. 

For your assistance in this process, Office Ally offers EHR 24/7. Medical providers and practices across the United States use this web-based electronic health record.

3. Implement Standardized Data Entry Practices

Healthcare data is generated from various sources, including electronic health records, medical devices, and patient self-reports. This data must be standardized for easy integration to fully understand a patient’s health. A hospital should agree on a data format that uses uniform classification systems and codes. This supports shared knowledge straightforwardly.

Standardized data is also important for audits. Auditors won’t be able to make sense of jumbled data and can deny claims if data is submitted in formats incompatible with their systems. Ensure your team uses a uniform standard for data entry that aligns with auditor requirements. 

4. Utilize a Backbone Platform

A “backbone platform” is a technology-based solution that manages your audit response process. A good software solution integrates your health system’s data and leverages it to increase overall efficiency through automation.

An audit is a multidisciplinary process that involves many hands from different departments. Passing the process through so many hands increases the risk of a mistake. An audit backbone brings all audit requests into one system. It keeps everything aligned for workflow optimization. Management software can make all the difference in identifying your financial exposure. It also helps determine your team’s effectiveness in protecting reimbursement.

5. Educate & Train Your Staff On Audit Procedures & Requirements

While technology can drastically reduce the odds of human error interfering with an audit, it doesn’t eliminate it entirely. Staff must be trained on all aspects of audit procedure, including:

• Documentation
• Software usage
• Policy regarding patient files
• Patient privacy
• The audit process

Employees should also receive regular, individualized education on their role in auditing. A good training method is participating in analyzing and improving processes for future audits. 

6. Establish a Timeline for Audit Preparation Based On Audit Deadline

Understanding and implementing expected timelines is key to a successful audit response. Managers should know how long an audit response will take for their team and prepare accordingly. Consider an auditor who demands hundreds of documents. The response should start earlier than a request for a single pre-payment review. 

7. Leverage the Electronic Submission of Documentation

If you’re still sending documentation through the mail, it may be time for an upgrade. Electronic documentation between your organization and the auditor saves valuable time and money. It can also increase security and compliance and help your organization find its footing in an increasingly remote world.

Many backbone solutions discussed above include a system for easy document submission. Investing in such software is a simple workaround. The complex alternative is developing and integrating your own electronic submission capability.

8. Only Provide Documents & Records Directly Requested

Many healthcare audit requests require massive documentation and effort from staff. They must take the time to find, locate, and organize these documents. These burdensome requests can cause team burnout and strain on internal resources.

Providing only information required by the auditor simplifies the workflow. There’s no extra prize for sending extra documentation. In fact, the auditors who have to review the information sent over will likely thank you for making their jobs easier, too!

9. Revisit & Rethink Your Approach to Reporting

Tracking and comparing your data monthly helps you stay on top of current trends. It also helps you find any increases in financial exposure, new audits, and lost reimbursement.

Take account of the services you provide and keep track of audit-related trends coming down the pipeline. All Medicare audits are posted on the CMS website, so check it often and cross-reference it with your internal reports. For example, you see CMS is posting an increase in telehealth audits. You saw a huge rise in telehealth appointments last year. Your reports also show you haven’t successfully protected reimbursements from telehealth audits. Now, you know where to concentrate audit response resources in the near future.

10. Review & Address Findings from the Healthcare Audit

The audit isn’t over until staff have reviewed the auditor’s findings and recommendations and responded appropriately. Take note of the results and implement any corrective actions as quickly as possible. Any changes in policy or mandatory training should be communicated to the staff at large. 

Remember, contacting auditors again can be an acceptable next step. Working collaboratively to understand their recommendations better can improve your long-term outcome. By correcting properly now, your team will avoid facing denied claims or new audit inquiries for the same issue in the future.

11. Conduct Regular Internal Audits to Get Ahead of Unexpected Audits

Potential penalties for audit findings can be a serious hindrance. They may include fines, loss of licenses, or other penalties impacting a hospital’s revenue cycle. It’s important to take audit risks seriously to avoid these consequences. 

Audit response software

Regarding audit response, the best offense is a good defense. Conduct regular internal audits now to prepare for future external inquiries. Make sure staff is acting on these 11 strategies and following organizational policies. Reviewing processes can identify problems or concerns before an actual audit. 

Need a hand? Audit & Denial Tracker provides a comprehensive audit management and response platform for hospitals and health systems. It’s the most powerful audit management and response solution available in the market today. Click here to learn more about Audit & Denial Tracker and proactively improve your audit process.