Hayes' Healthcare Blog

Leveraging Peer Collaboration and Information Sharing: 3 Things to Think About

Posted by Robert Freedman on May 24, 2017 at 9:00 AM

An article in Inc. Magazine outlined five reasons why collaboration is crucial. While the article was focused mainly on business organizations, the concept is just as important for those in healthcare generally and for compliance and auditing professionals specifically.

The key reasons for working with peers in your industry are:

  • Self-awareness – Collaboration forces you to clearly describe areas of strength and weakness
  • Scale – “Two heads are better than one”
  • Creative Abrasion – Converting energy from people who are different into positive action
  • Take the long view – Ideas may not have an immediate impact but could be beneficial down the road
  • Learn, learn, and learn some more – Collaboration sets an expectation of continuous learning to expand the knowledge base of the organization.[1]

No person – or organization – has all the answers. The more you can work with peers at similar institutions facing similar challenges, the better the chances you can effectively address and successfully solve them. There are three things to consider that can help energize peer collaboration in your organization.

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Topics: mdaudit, Data analytics, Risk-based audits

4 Opportunities Analytics Can Provide

Posted by Robert Freedman on March 29, 2017 at 9:00 AM

The risks of non-compliance in the healthcare industry have never been greater. In fy2016, the HHS Fraud and Abuse Control Program returned $3.3 billion to the Federal government and private parties. The Department of Justice (DOJ) opened 975 new criminal health care fraud investigations.[1]

In fy2015, Medicare Recovery Audit Contractors (RAC’s) identified and corrected 619,000 claims resulting in $441 million in improper payments - $360 million in recovered overpayments and $81 million in underpayments repaid to providers.[2]

With both top and bottom lines continuing to shrink, you can’t afford to be hit with a massive overpayment penalty or to undercharge for patient activity by hundreds of thousands of dollars.

The key to managing both risk and opportunity is getting into your billing and collections data, and for that you need a robust analytics solution. Here are four opportunities you can take advantage of with a comprehensive analytics program.

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Topics: mdaudit, Healthcare Analytics, Risk-based audits

Defining Your Terms: Do You Have the “Analytics” Solution You Really Need?

Posted by Robert Freedman on November 16, 2016 at 9:00 AM

Big Data. Bandwidth. Paradigm. Analytics?

It’s almost universally accepted that the first three have crossed over into buzzword territory and are in danger of losing any real meaning (if they haven’t already done so.) But is the term “analytics” heading down the same road?

We’re not saying analytics aren’t important. In fact, they are critical for healthcare organizations facing the onslaught of changes resulting from MACRA, increased oversight and the rush to value-based care.

But it’s important for us to define our terms. “Analytics” does not mean the same thing in all situations. In order to get maximum value, you need to make sure the analytics solution you’re using is appropriate for the task you are trying to accomplish. If it isn’t, you’re not likely to achieve your desired goals.

We spoke with one prospect recently who said, “Analytics is off the table. We already have so many analytics products. We don’t need any more.”

His situation may not be very different from your organization where you have no doubt deployed a number “analytics solutions.” You may have a large, expensive enterprise system in place. But if you’re like many organizations, those analytics programs are often focused on “bigger picture” issues like population health. While that is an extremely important initiative, as a compliance organization, you still need to leverage data for other operational goals like improving revenue flow and minimizing risk.

You may also have a number of system-specific analytics programs and visualization solutions that can provide valuable insight. Unfortunately, although these applications fall under the broad heading of “analytics,” they don’t provide answers that relate directly to your set of issues.

The end result is that even though your organization may possess powerful “analytics” solutions, you can often be left hungering for “analytics” that help you focus on your key risk areas. You may have trouble getting directly to the raw data you need but instead have to rely on filtered data provided by someone in an IT group. Such data sets compiled outside the compliance group can reflect a different purpose from the one you need. 

Actionable analytics requires iterative refinement of available data with subject matter experts who can pull out the “learnings” that are real and worthwhile. To accomplish that you certainly need “analytics,” but analytics that use raw billing and coding data to uncover risk areas before they can cause reputational and financial damage. These types of “analytics” solutions are much more specific. They are built on an analytics platform, but they are actually applications.

When looking for an analytics application best suited for risk and compliance management, here are five things you need.

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Topics: Healthcare Analytics, Risk-based audits

Risk-Based Auditing: Why It May Be The Right Choice for Your Organization

Posted by MDaudit Team on April 13, 2016 at 9:00 AM

Authors: Carrie Walters-Derksen and Susan Horahan

In a recent survey of Chief Audit Executives, an increased focus on risk management was named the top initiative by 60% of respondents.[1] The continuing growth of regulatory compliance demands in the healthcare industry – and the heightened risk that comes with it - is placing an enormous strain on auditing resources in most organizations. Deploying those resources in the most effective way means narrowing audit focus to those areas that pose the greatest risks.

The growing adoption of this type of approach explains why risk-based auditing is such a hot topic in healthcare circles today. With only so much time available for auditing, it’s critical for organizations to target specific areas of interest and not devote time to areas with little or no significant impact. Moving from an annual risk assessment program to a risk-based audit plan can be one of the most important moves a healthcare organization can make.

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Topics: OIG Workplan, risk management, Risk-based audits

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