5 tips for making your claims audit-ready
Faced with more audits? Most HMEs are. Without a sound strategy for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organization at financial risk.
When an audit strikes, the best approach is a quick response with proof that all documentation complies with requirements. How do you achieve this? Follow these five steps:
- Give CSRs tools to improve intake
Customer service representatives (CSRs) play an essential role in the audit process. They typically collect the right information at the start of service. Unfortunately, staff turnover and changing requirements make it difficult to keep CSRs current on payer requirements.
Technology can fill the knowledge gap. Make sure your tech tools do more than just park data in a form. They should prompt CSRs to collect specific documentation, which enables correction of the claim before it is filed.
- Know the validation rules
Improve efficiency by helping CSRs collect payer-specific requirements through established validation rules. Medicare rules may call for a document to support specific Healthcare Common Procedure Coding System (HCPCS) codes. Other payers may have a looser set of rules that don’t require the same level of documentation, saving time for the CSR.
- Enable a quick audit letter response
Your staff should be able to access documentation quickly to respond to an audit letter. But that’s not always easy in the case of a long-term service. Establish a link between billing records and the sales order documentation to eliminate the risk of error. Make sure you can gather the information efficiently. Advanced HME systems allow users to collect, submit and track documentation electronically in response to CMS audits.
- Automate document review within workflow
What if you need to deliver a critically needed product before you can complete documentation? You’ll need to review documentation carefully before submitting the claim to ensure progress notes support medical needs and meet requirements.
HME providers can easily determine whether or not to delay confirmation of a claim by automating the review process throughout the workflow. Use optical character recognition technology and install checkpoints that alert staff to missing or inaccurate information.
- Capture data on all patient care interactions
Setting up a process to capture all telephone calls to patients, verbal orders from physicians, or communication with other providers is critical. The number of people involved in each case make it difficult.
Technology that documents actions by time, date and personnel involved provides additional support as you demonstrate compliance with billing requirements.
There’s no sure way to guarantee you won’t go through an audit. The right HME business technology will prepare you to take on audit challenges. With proactive compliance and timely response submission, audits can be resolved, and claims paid faster, leading to improved cash flow.
As we continue to grow our business through acquisitions, Brightree Document Management makes it possible to have required documentation right at our fingertips. Brightree gives us the confidence of always being audit-ready.
Why do providers turn to Brightree to become audit-ready?
As a part of Brightree Document Management, our Electronic Audit Response solution enables users to collect and submit documentation electronically in response to CMS audits, and track status on a safe and secure application. With this solution, providers significantly reduce the time spent chasing documents and submitting paper-based responses. Click the link to learn more.