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Let’s talk about audits HomeTown Health

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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 - PowerPoint PPT Presentation

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Page 1: Let’s talk about audits

Let’s talk about audits

HomeTown Health

Page 2: Let’s talk about audits

Topics

• Background

• Trends

• Financial risks

• Discovery Audit Management Support services

• Next steps

Page 3: Let’s talk about audits

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

04/21/23 Company Confidential 3

Government Alphabet

Page 4: Let’s talk about audits

Audit relationships

04/21/23 Company Confidential 4

Page 5: Let’s talk about audits

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

04/21/23 Company Confidential 5

Page 6: Let’s talk about audits

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

04/21/23 Company Confidential 6

Page 7: Let’s talk about audits

04/21/23 Company Confidential 7

Page 8: Let’s talk about audits

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

• Detailed reporting04/21/23 Company Confidential 8

Page 9: Let’s talk about audits

04/21/23 Company Confidential 9

Page 10: Let’s talk about audits

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

04/21/23 Company Confidential 10

Page 11: Let’s talk about audits

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

04/21/23 Company Confidential 11

Page 12: Let’s talk about audits

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

04/21/23 Company Confidential 12

Page 13: Let’s talk about audits

Questions

04/21/23 Company Confidential 13

RELAX !


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