Hayes' Healthcare Blog

Quality Management is a familiar concept in healthcare, especially when it comes to organizational excellence and patient safety. Minimizing risks and ensuring safe outcomes for those under your care are critical goals in every healthcare setting.

But patient care isn’t the only area where quality management matters. An effective quality management system is an essential element of a revenue integrity program. In order to provide the best healthcare to your patients, you must build a strong revenue integrity foundation that ensures a financially viable organization. To reach that goal, you need a quality management approach that incorporates auditing and corrective action to optimize every aspect of your business and revenue cycle operations.

Healthcare organizations take pride in building and maintaining an effective internal auditing team. A robust internal audit program is crucial to avoid the perils of penalties and overpayments that can sabotage both top and bottom lines. Yet despite their best intentions, healthcare organizations that rely exclusively on internal monitoring and auditing functions – regardless of how effective they may be – can face significant pitfalls. 

To ensure that the organization's financial operations are performing to the required standards, it is essential that billing compliance programs go through periodic reviews from an independent, external entity.

By Susanna Partrick, Senior Privacy and Compliance Administrator, Weill Cornell Medicine

Nearly eight out of ten healthcare internal auditors in a recent survey by PwC believe risks are increasing. As a result, almost nine out of ten say they have gone through or will soon be involved in significant business transformation. The conclusion is that these increased risks and transformative changes in the healthcare industry will require internal auditing to change as well.[1]

Unfortunately, few healthcare organizations are able to add resources during a time of shrinking revenue and tightening margins. To meet this increased demand, therefore, those of us responsible for the internal compliance program functions must find ways to be more efficient with the resources we do have.  Doing more with less has become an inevitable mantra for compliance auditing groups in healthcare organizations striving to minimize overall risk.

The concepts of productivity and efficiency are often viewed negatively – as simply buzzwords to wring more output from overworked staff. That doesn’t have to be the case. A huge part of our responsibility as leaders is to work cooperatively with our teams to improve the amount of work being performed by optimizing their skills, our processes, and the technology under our control.

Here are five key steps you can take to improve the productivity and efficiency of your compliance audit team.

Success has never felt so good. We have successfully met and surpassed the national ICD-10 implementation from October 1, 2015.  If you were like most organizations, you were ready a year in advance.  Others, however, were relieved when CMS postponed the original go-live date of October, 2014 to a year later.  Some physicians have been very vocal about the challenges involved in learning a new coding system, and we continue to see growing pains as the new ICD-10 codes are implemented. With reimbursements in full swing, how do you ensure your organization is successfully and efficiently implementing all these changes?

One way you can ensure this is by creating, implementing and optimizing an official audit process.

Minimize Liability, Mitigate Risk and Maximize Safeguards

Corliss Collins, RHIT, CCA, CBCS, Senior Healthcare Consultant, AHIMA Approved ICD-10 Trainer /Ambassador

HIPAA compliance audits pose significant challenges for hospitals, healthcare providers, health plan administrators and business associates.  The Office of Civil Rights, (OCR) Phase II Audits will begin early this year and, will focus on organizational privacy, security, and breach notification policies, procedures and practices.

Healthcare organizations need to be prepared to undergo greater scrutiny in three key areas, including written policies, procedures and practices that address HIPAA compliance risks, and vulnerabilities. Are HIPAA compliance audits and risk assessments being performed regularly? How is documentation of HIPAA breach incidents within your organization responded to?